Methicillin-resistant Staphylococcus Aureus (MRSA) is a
bacteria that is resistant to many antibiotics, including most penicillins.
Aureus is harmlesly present on about a third of the population, and is a regular
cause of skin and wound infections; before the resistant strains, few staph infections
caused major concern, and the bacterium was often considered a contaminant.
however, Staphylococcus Aureus wound infections are a significant cause
of extended hospital stay - and death. MRSA septicaemia can prove fatal, if untreated,
in any patient. In some surgery (eg cardiac surgery), MRSA can be a direct cause
of death; in other surgery - eg joint replacement in older people - MRSA is often
an indirect cause of death; weakening the patient and delaying rehabilitation
and restored mobility, allowing other opportunistic infections to develop, causing
(for example) pneumonia.
These 'indirect' deaths were often not reported
in mortality statistics, one reason why MRSA was not taken seriously for a lng
time. It is impossible to know the extent of current under-reporting, as many
people do not challenge certification of death, and the extent to which MRSA has
contributed is often not easy to evaluate.
MRSA usually found?
Staphylococcus infections, including MRSA, occur mainly
in hospitals and other healthcare facilities (such as nursing homes and dialysis
Staph infections include wound, urinary tract, blood infections,
and pneumonia. MRSA pneumonia is uncommon outside of intensive care units.
is increasing recognition that people living at home can carry the infection (without
being infected), providing a reservoir of infection.
common is MRSA?
Staphylococcus Aureus infections of the skin are
common, even in otherwise healthy people. MRSA infection is much less common,
and serious or life-threatening MRSA infections are rare. It is important to remember
that the majority of people who are described as "MRSA positive" are
colonized, rather than infected - they are carrying the bacteria, either on the
skin, the membranes of the nose and throat, or possibly on a chronic wound (such
as a venous ulcer), without having any symptoms or harm associated with it.
is MRSA transmitted?
As it is primarily a skin infection, skin-skin contact
is bar far the most frequent route of spread. The hands of health-care professionals
are undoubtedly responsible in many cases, but family contact is a mjor factor.
always fascinated by the obvious fact that sick patients tend to be hot and sweaty;
many health care facilities are seriously overheated, with more hot and sweaty
residents. The increased likelihood of happy MRSA bacteria spreading from sweaty
palm to sweaty arm (and vice versa) is really frighteneingly obvious.
seems to me that investigating this local "greenhouse effect" is long
overdue, but who am I to state the obvious!!
most at risk?
Staph is an opportunistic infection, so those at greatest
risk are older people, very young people, those with reduced immunity to
infection (including those living with HIV or anti-cancer therapies), and
long-term residents of health care facilities.
One study that set out to identify risk factors found that recent hospitalization,
outpatient visit, nursing home admission, antibiotic exposure, chronic
illness, injection drug use, and close contact with a person with risk
factor(s). Most MRSA colonization occurrs among community members who had
risk factors or contact with persons with risk factors. The evidence indicated
that control of MRSA in the community may require control of MRSA in the
health care setting (hospital, health care office, and nursing home).1
are the symptoms of MRSA?
Staphylococcus Aureus infections of the
skin show as spots, pimples or boils, often with local inflammation. in wounds
there is no distinctive appearance or odour - but delayed healing is a feature.
Blood infection (septicaemia) follows similar pattern to other bacterial blood
How is MRSA diagnosed?
of the presence of MRSA is by microbiological testing; microscopy, culture and
sensitivity. A specimen - usually a swab - is taken and cultured (allowed to grow
in the laboratory) then tested against a range of antibiotics to assess their
effectiveness - or the presence of a resistant strain.
Methicillin is an
antibiotic used almost entirely within laboratories; methicillin resistance was
taken to mean 'resistant to most penecillins'.
Microscopy, used in conjunction
with the above, will confirm the presence, and the strain, of MRSA
there a treatment for MRSA?
Yes. There are two approaches to this.
where there is contamination or colonisation, MRSA may be treated with a strict
hygiene regime. This will include care with contact, daily linen and clothes changes,
washing and bathing with specific antiseptics, lotions and talc.
or deep wound MRSA infections are treated with antibiotics.
will be observed, possibly drained, but antibiotics will not be used unless this
is found to be unavoidable, as there is a serious risk of antibiotics developing
further resistance; and many skin infections can be resolved as effectively without
antibiotics as with them.
Is there a way to prevent
Good hygiene. It really is that simple.
1. Hand hygiene
is vtal, especially for health professionals, and those in close contact with
people known to carry the infection.
2. Take cuts and scrapes seriously, cleaning
and dressing wounds appropriately with occlusive dressings.
3. Be careful
with soiled dressings, and clothes and linen from those with the infection.
4. Never share personal items such as towels, toothbrushes or razors.
is the mortality rate for MRSA?
Most of the MRSA-related deaths occur in
older age groups. In 2004, mortality rates in the '85 and over' group were 546
deaths per million, for males and 258 for females. In the 'under 45s', there were
fewer than one death per million of the population.
In individuals, mortality
rates are based on those diagnosed with MRSA bacteraemia - blood infection - and
most sources estimate this at 30-40%. The risk of bacteraemia in colonized patients
is very, very small, rising in those who require surgery, and in particular, those
who have MRSA deep wound infections, or infections associated with intravenous
or other penetrative devices.
Can MRSA be controlled
While MRSA in an individual can be effectively managed
with antisptics or antibiotics, MRSA as a public health issue can ONLY be managed
environmentally; large scale use of chemicals will ultimately result in greater
resistance problems, increasing, rather than decreasing the risks to us all. How
do you think MRSA developed in the first place?
Improving compliance with
hand hygiene and screening for and decolonization of CA-MRSA carriers are
effective strategies. However, hand hygiene has the greatest return of
benefits and, if compliance is optimized, other strategies may have minimal
What can I do if MRSA is
found on my skin?
Use whatever treatments are provided or recommended by
your doctor or pharmacist, and take all the advice you are given - there is no
'magic bullet' for MRSA.
If you have MRSA, and are at risk from its effects,
then there are measures you can take to help yourself. These four points may help
- but not if they contradict specific advice you have received from health
First, healthy diet and sufficient vitamins will help, as
will plenty of exercise and time outdoors - a healthy body is less prone to these
kind of infections.
Second, hygiene is important; it reduces the skin load of
bacteria - in many cases, reinfection from the skin is part of the problem. So
shower, not bath; use clean dry towels, change underclothes frequently, especially
if you sweat a lot.
Third, if you have any co-existing skin conditions
- eg eczema - be sure they are treated too, as they can harbor infection. If your
skin tends to be dry, use a moisturiser cream. Flaky, dry skin provides places
for bacteria to hide.
Fourth, Powerful cleansers are usually NOT the answer;
they often damage the skin, and may not be appropriate for your particular infection.
More gentle cleansers used regularly, are often better - but see if your doctor
or pharmacist can recommend one for you.
None of these points is guaranteed
to solve the problem, but they could be a great help.
there legal protection for workers and others?
People at risk from MRSA
can easily protect themselves with simple hygiene measures; the issue is "who
knows" - health care professionals should always know which of their clients
carries potentially dangerous infections, and they may have a case against their
empoyer if not forewarned, and later harmed.
Visitors (in hospitals, for example)
may be faced with the 'confidentiality barrier' - which is fine, so long as ALL
visitors are educated on appropriate anti-infection measures.
and Further Information Sources
Methicillin-Resistant Staphylococcus aureus: Prevalence and Risk Factors - Joel W Beam and Bernadette Buckley
the Invasion of Community-Acquired Methicillin-Resistant Staphylococcus
aureus into Hospitals - Erica M. et al
I regret I cannot assist with individual cases or essays and school projects,
but if it's something I've missed, I'll be happy to try and help.
Article written by Andrew Heenan BA (Hons), RGN, RMN