MRSA - Methicillin Resistant Staphylococcus Aureus Fact sheet

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics including methicillin and other more common antibiotics such as penicillin and amoxicillin. This means that treatment may be longer and more expensive.
 
That’s why MRSA infections have become a topic of concern for hospitals and long-term care facilities during the past decade.
 
MRSA is resistant to all beta-lactam antibiotics, which includes all penicillin medications and a very big group of medications called cephalosporins.
Infections with this species of Staphylococcus are present most frequently among persons in hospitals and healthcare facilities. The first documented MRSA outbreak in the United States occurred at a Boston hospital in 1968.
 

The fact is that this bacterium is commonly found on human skin and the most common places include the inside of the nose, the armpit, groin, and genital area.
When a person carries the bacterium which is causing no problems or illnesses of any kind, it is called colonization. When the bacteria do cause illness it is considered that this person is "infected" with Staphylococcus Aureus.

Target population and risks

Older or very ill hospital patients are the most common target population for the Methicillin-resistant Staphylococcus Aureus. People who use antibiotics frequently, long intensively or for a long period of time, as well as the intravenous drug users, are at a higher risk of developing this kind of infection. Patients that are under strong immunosuppressive therapy like those who were diagnosed with some kind of cancer are also at an increased risk.
 
However this can happen to everyone who had some kind of operation because an open wound is also a possible entrance for these bacteria. Methicillin-resistant Staphylococcus Aureus rarely attacks healthy people.
 
People that have a urinary catheter should also be aware that they belong to the high-risk gropu of  patients.

Transmission

These infections were always associated with hospitals, but in the last couple of years, physicians and other healthcare providers have noticed an increasing number of people infected with MRSA who lack the most common risk factors.


Therefore, there are two types on infection:

•    Community-associated MRSA (CA-MRSA) infections
•    Healthcare-associated MRSA (CA-MRSA) infections


Recent and excessive antibiotic use, recurrent skin diseases, and bad living conditions are the most common risk factors for MRSA infections in the community.
It is proven that MRSA lives on skin and survives on objects and surfaces for more than 24 hours. The fact is that MRSA is usually spread by direct, physical contact. An indirect contact is also very important from the epidemiologic point of view because MRSA can also be spread through contact with objects such as towels, sheets, workout areas and sports equipment that have the bacterium on them.

Symptoms of Staphylococcal infection

This sort of Staphylococcus produces almost the same symptoms as any other type of the Staphylococcus bacterium.

The most common symptoms are:

•    red and inflamed skin around the wounds
•    fever
•    lethargy
•    headaches
•    redness, swelling and tenderness at the site of infection

Serious symptoms may include:

•    urinary tract infections
•    pneumonia
•    toxic shock syndrome
•    death

How long do these infections last?

The problem with these infections is that sometimes, if the person is completely healthy, it can carry the bacterium in their nose or on their skin for weeks or even years. Most of them think that they need no treatment but the fact is that, unless completely cleared the bacteria can return, especially if the individual is under some kind of antibiotic therapy.

Diagnosis of Staphylococcus Aureus infections

The definitive diagnosis of Staphylococcus aureus infection is made by taking the culture from the area of suspected infection. The specimen is placed on a culture plate and incubated in special thermostats. Then the bacterium is being identified by the microbiologist.
 
The final step for the laboratory is the resistance testing, which should determine if the bacteria are resistant or sensitive to certain antibiotics. If the bacteria that were cultured in the place of infection can't be killed with standard antibiotics then the infection is called MRSA.

Clinical presentations of this condition

Infections with Methicillin-resistant Staphylococcus Aureus can cause a number of different clinical forms such as:

•    Cellulitis – superficial inflammation of the skin
•    Impetigo – superficial lesions or abraded skin with honey-colored crust and small blisters on them
•    Folliculitis – Infection of the hair follicle
•    Furunculous – Deep infections below the hairline. Target spots are the hair follicles and substructures
•    Abscess – Pus-filled mass that in most cases is located below all the superficial skin structures
•    Infected laceration – Infected cut, that was there before the infection

Treatment

Treatment of Methicillin-resistant Staphylococcus Aureus infections has always been a problem, even for experts in this field. Even now, there is neither an effective treatment nor evidence-based recommendations for the eradication of this Staphylococcus type!
 
Some MRSA infections can progress to serious and possibly life-threatening infections and these infections may require intravenous antibiotic treatment.
 
However, there is something called the  “interim guidance” that should point a health provider to do everything in his power to treat the infection.

Some of these instructions are:

•    incision, drainage, and localized care are the first line of treatment
•    management of skin lesions and selective use of antibiotics should be continued even if the MRSA is found in the lesions
•    initial treatment should start with medications that are used normally against Staphylococcus Aureus such as cephalexin or dicloxacillin. If the bacterium shows to be resistant of classical therapy, the culture and resistance test should be done in order to find an effective medication
•    in patients with recurrent and serious MRSA infection, or in families with many affected members, some experts would consider attempting eradication of MRSA colonization. In such cases, Bactroban or Rifampin, in conjunction with another antibiotic effective against MRSA, may be helpful
•    good hygiene practices with patients which includes hand washing, washing of the contaminated items with warm water and soap, and proper disposal of the contaminated bandages and wound coverings
Patients that have urinary catheter installed and their health providers should also follow some special instructions:
•    Urinary catheters should be changed only when necessary
•    Closed drainage system should be maintain
•    Drainage bags should be kept off the floor. Use a separate container for collection of urine from each patient. Container should be disinfected after each use.
•    Wash and dry toughly the patient’s perineal area minimum of once per day or anytime it becomes soiled.
•    Secure the catheter to the patient to avoid tension on it.
•    Hands should be washed after manipulating the catheter or collecting urine

Isolation of the patients

This can vary from hospital to hospital. In some hospitals, especially if they are smaller ones, patients with MRSA may have to be isolated, and in some, this isn’t necessary.

Isolations are needed especially if the infection is in a wound that is draining or in the lungs and they are coughing. In most cases, all the patients, which are diagnosed with these strains of bacteria, may be placed in a same room with other patients that also have MRSA.

Prevention of MRSA infection

There are several standard infection control precautions and some of them are:

•    Gloving – Gloves should be on hands all the time, especiallywhen touching blood, body fluids and contaminated items.
•    Hand washing – Hands should be washed immediately after gloves are removed, between contacts with patients and other common daily tasks and procedures.
•    Masking – Masks should be wore during all procedures that are likely to produce splashes or droplets of blood and body fluids.
•    Patient care – several hygiene measures such as appropriate cleaning, disinfection and sterilization of patient care equipment are very important as some of the best limiting factors for the transmission.
•    Antibiotics usage – Usage of antibiotics that aren’t necessary should be avoided!

If you are already diagnosed with MRSA infection, there are several things you could do to prevent it from spreading to other people:

•    Keep infections covered with clean, dry bandages.
•    You must follow your doctor’s instructions for collecting the pus from the wound because it can also contain the bacteria
•    Wash hands after touching the infected skin and bandages
•    Dressings and bandages should always be placed in a separate trash bag, which should be closed before throwing out with the regular garbage.
•    Do not share any personal items including towels, washcloth, razor, clothing, or uniforms
•    Drying clothes in a hot dryer instead of air-drying is recommended because it is more deadly for the bacteria
•    All contact sports or other skin-to-skin contacts including sexual contact should be avoided until the infection has treated and healed.
•    Avoid using unnecessary antibiotics.