Methicillin resistant Staphylococcus aureus

There are 2 types of MRSA: Community-acquired MRSA (CA-MRSA) This is passed throughout a community. You hear about school outbreaks often. Hospital-acquired/Epidemic MRSA (EMRSA) Generally the infection is acquired during a hospital stay.

MRSA was first noted in 1961, two years after methicillin use began. The resistance is caused by penicillinase. This enzyme destroys the penicillin binding protein. MRSA is termed a “superbug” because of its ability to become resistant to several antibiotics. MRSA is known for causing skin (Staphylcoccus aureus) infections.

Cellulitis: superficial infection of skin or fat and tissues This starts as small red bumps on the skin. Boils: pus filled infections common in hair follicles

Abscess: collection of pus under the skin Sty: infection of an eyelid gland

Carbuncles: infection that is larger than an abscess. Usually you will see several openings. Impetigo: skin infection that exhibits pus-filled blisters

Symptoms include fever, chills, low blood pressure, joint pain, severe headaches, shortness of breath, and/or a rash covering most of the body. My uncle acquired EMRSA while staying in a hospital. He has since recovered,but it took almost 2 years and he almost died twice!

During an active infection, transmission occurs when there is physical contact with the carrier. Physical contact with fomites (objects that aid in the transmission of infection) such as door handles, floors, sinks, towels, etc. People at high risk for contracting MRSA: people with obvious skin breaks, surgical patients, hospital patients with I.V.’s, burn patients, patients with skin ulcers, people with depressed immune systems, infants, elderly, people with chronic diseases, people who have Diabetes Mellitus or Cancer.

Pneumonia MRSA is spread by droplets that are airborne. Health care workers are especially at risk for contracting pneumonia MRSA. If there is a patient with MRSA, health care workers will wear gloves, gown up, and put on a face mask.

In order to get a diagnosis, they need a sample to look at. The sample can come from skin, pus, blood, urine, or a biopsy of the infection site. Once they have the sample, they will culture S. aureus and then expose it to different antibiotics. If the sample grows well with Methicillin then it confirms MRSA. This tends to be a time consuming method. You can carry MRSA and not even know it! To test for carriers, they will swab your skin or a mucous membrane. When I worked in Idaho Falls, I had a co-worker die from MRSA getting into his lungs. They caught the MRSA when they swabbed his nose.

Recently on January 2, 2008 the FDA cleared a rapid blood test for MRSA for use. It is made by GeneOhm and is called StaphSR assay test. At this point, it can detect CA-MRSA in 95% of skin and soft tissue infections.

Excellent hand washing is essential. Using good hygiene practices will help keep you safe as well. Washing clothing, not sharing towels, razors, or personal hygiene products, and using disposable items is helpful. Avoid direct contact of a known MRSA source or infection!

Treat and cover skins breaks immediately. Use antiseptic cream and a bandage. Proper wound care is essential as well. You must dispose of used bandages appropriately. Don’t forget to wash your hands!

Keeping surfaces and fomites clean will help deter the spread of MRSA.

When treating MRSA you cannot use any Methicillin derived antibiotics. Common antibiotics used are Linezolid and Vancomycin. For the treatment of carriers of MRSA they use Mupirocin or Bactroban antibiotic cream.

Maggot therapy is gaining ground in the treatment of MRSA. The maggots will eat the necrotic (dead) tissue. The MRSA does not harm the maggots because the maggots secrete an enzyme that kills MRSA.

Current research shows it may be possible to use a specific virus to kill off the MRSA cells.

1.2 million hospital patients are infected each year. 67% of non surgical medical wards test positive for MRSA. Mortality rate of MRSA is between 4-10%. With all of the Vancomycin use to treat MRSA, we are now seeing VRSA (Vancomycin resistant staphylcoccus aureus)! VRSA is an invasive infection that causes bacteremia, septic arthritis, Toxic Shock Syndrome, osteomylitis, and endocarditis.

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