Question:
My husband, who has had sinus problems for years (and two sinus surgeries), sees an ENT, Dr. Raymond Schettino, every three months. A recent culture showed an infection, and the doctor prescribed a nebulized Vancomycin solution. The office did not let us know the results of the culture, only that it was positive. When I discovered he was taking Vancomycin, I became worried that he could have MRSA, so I asked my husband to contact the office to find out the results. Sure enough, he does have MRSA in the sinuses. I have three questions:
1) Is Vancomycin via nebulizer known to work on MRSA?
2) Is MRSA in the sinuses highly contagious?
3) What kinds of precautions should my children and I be taking to avoid contracting MRSA in the sinuses?
4) Is MRSA in the sinuses becoming more common among healthy people:
I am upset that this office didn’t let us know that my husband had a MRSA infection. When I called and mentioned this to the nurse, she waved me off, saying that any infection is contagious.
Answer:
First of all, thank you for your question. It really poses quite a few issues about both sinus infections and MRSA.
We certainly believe strongly that sinus infections should be treated, based on a culture. However, a positive culture does not mean the same thing as an infection. We all have bacteria in our body and our nose and sinuses, especially. Staphylococcus is a common bacteria on all of our skin and in our noses. MRSA is a type of staphylococcus that is resistant to the usual antibiotics we use for a staphylococcus infection. Many today are carriers of MRSA in their sinuses and nose, without actually having a sinus infection. The difference one needs to make is clinical. – i.e. is the patient sick?
Vancomycin is a very strong medication, used for resistant organisms. The usual recommendation for MRSA carriers in the nose is topical Mupiricin ointment (Bactroban).
I know of no good studies about the use of Vancomycin as a nebulizer, although it certainly is used for this by many.
Additionally, different strains of MRSA are able to be treated successfully with more common medications. Most MRSA in the community can be well treated with Bactrim- an old sulfa medication- which would be preferable to using Vancomycin, if possible.
MRSA is not especially contagious. The problem is that we (docs) usually treat infections with antibiotics that will not work against MRSA, and we may not realize it is MRSA until the patient gets sicker on medications. Today, we will often treat initially with medications that work against most MRSA.
In order to avoid getting MRSA, like any infection,- wash your hands frequently and cover your mouth when sneezing.
MRSA is becoming quite common in the community, today, in normal healthy individuals- replacing the previous types of staphylococcus. If your husband had MRSA- either as a healthy carrier- or as a cause of infection- I would suggest that you and your family members see your doctor for a culture. Most infectious disease doctors would probably not treat an MRSA carrier unless you are working in health care or are closely in contact with a newborn or someone with a weakened immune system. However, should you develop an infection in the future, we would know to treat you with something that would cover MRSA.
Robert L. Pincus MD
Associate Professor Otolaryngology
Co-Director NY Sinus Center/ NY Otolaryngology Group
