November 16, 2007

Child’s ordeal sheds light on mysteries of MRSA

Featured Image

Julia’nna Clemmons, 5, during her treatment at the Monroe Carell Jr. Children's Hospital at Vanderbilt for community acquired MRSA. (photo by Dana Johnson)

Child’s ordeal sheds light on mysteries of MRSA

Buddy Creech, M.D.

Buddy Creech, M.D.

When Julia'nna Clemmons left the Monroe Carell Jr. Children's Hospital at Vanderbilt last Thursday, the local media called it a “miracle.”

The 5-year-old Rutherford County kindergartener's family agrees and staff at the hospital say the youngster came as close to death as any child could from methicillin-resistant Staphylococcus aureus (MRSA).

Julia'nna arrived at Children's Hospital on Friday, Oct. 12. “Her breathing was getting real labored and she had this high fever,” recalled her father, Julian Clemmons.

By the middle of the following week, doctors knew the bacteria had formed large pockets of infection in her right knee and both lungs. By that weekend, it had gone to her heart and brain. Her kidneys had ceased functioning and she was completely reliant on a ventilator to breathe.

“I remember having that conversation with the family,” said Buddy Creech, M.D., assistant professor of Pediatric Infectious Diseases. “That we had tried everything we knew to try, but it had not stopped the infection.”

The family was told they should notify relatives and prepare for the worst.

But by Monday, Oct. 22, Julia'nna was still here, still hanging on. Then 48 hours passed and she began to regain consciousness. She was taken off dialysis and her kidneys worked. By Halloween, she was in a regular room, taking part in the Children's Hospital's reverse trick-or-treat event.

“It was amazing,” Creech said. “It's a testimony to the team in the Pediatric Critical Care Unit. We tried different combinations of four antibiotics, but with each child like Julia'nna, it's hard to know what combinations might work best.

“We moved aggressively to drain the infection and we worked hard to stabilize her blood pressure. It's very gratifying to see her come to this day, to have recovered.”

Creech said Julia'nna has a good chance of full recovery, although she will need antibiotics for many more weeks and will undergo physical therapy to learn to walk again. He said the coincidental release of a major study and subsequent media coverage of Julia'nna's case created both a good opportunity to educate about MRSA, as well as unnecessary fear of MRSA on the part of the public.

The study, released on Oct.16 in the Journal of the American Medical Association, found that thousands of Americans are getting MRSA infections, and that the infection is close to killing more Americans than AIDS.

“It can be frustrating for us as physicians to try to help the public make sense of reports in the media like those that surrounded Julia'nna's case,” Creech said.

“While the challenges involved with these cases are evident, we know cases like hers are still rare.

“We don't want parents to be overly concerned, and certainly don't advise them to take kids out of sports or other activities linked to staph infections. The trouble is deciding what to say about cases like this when the vast majority of MRSA infections in children and adults are simple skin infections that heal with minimal treatment,” Creech said.

It has been difficult for Julia'nna's parents to make sense of their daughter's illness as well. “It all began with a simple scrape on her knee,” said Julia'nna's mother, Amanda Hasty. “It wasn't but a week before we were preparing for the worst,” added Clemmons.

“In cases like Julia'nna's, there is no smoking gun,” Creech said. “Though she had probably been carrying the bacteria in her nose or on her skin for some time, we don't know the full set of circumstances that had to happen for her to become so ill. What would really help us, as physician-scientists and public educators, is finding the answers to these very important questions.”

Creech and his colleagues are working on that. Their current research projects include examining what groups of people are most at risk for carrying MRSA, why some people get infections and others do not, and how the bacteria is spread from person to person.

In addition, Creech and his team continue to work with vaccine developers to test new MRSA vaccine candidates that could be given to those at high risk for MRSA infections.