To the Editor: In his Clinical Crossroads article, Dr Moellering1 discussed the natural history, risk factors, epidemiology, and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, using the case of a man with a recurrent skin infection. He noted the risks of infection from close and intimate contact in settings where such infections have been documented (hospitals, nursing homes, prisons, and athletic contacts). However, only the patient mentioned his family (the site of the most prolonged and intimate contact for most patients) and 1-year-old son, “who's been on [antibiotics] ever since birth.”
It seems likely that the son has only been treated empirically and never cultured, so it is probably unknown whether he has had MRSA. However, multiple family members can have simultaneous or serial infections with the same Staphylococcus organism. One such documented familial outbreak of MRSA began with a family member who was hospitalized; was identified later in the father of the family; and then continued through a 10-year-old son, the wife, and several other children.2
The Clinical Crossroads article does not state whether the patient's son was in day care, which has been shown to be a focus of MRSA,3 or in a play group, where he may have acquired his original infection. But it is plausible that the son's failure to clear infection is due to inadequately treated MRSA and that the index patient's recurrence of infection is because of reinfection from his son (or from his wife, who could be infected or a carrier). It is also possible that a previously methicillin-sensitive organism became methicillin-resistant because of recurrent use of ineffective antibiotics in the son without culture or testing of sensitivity.
If for this case the common focus of infection for MRSA is the family, then the treatment and eradication would be very different from what was discussed. Further studies of the epidemiology of MRSA, focusing on the family, are needed.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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