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31
October
2007

MRSA Merci!

MRSA stands for Methicillin-Resistant Staphylococcus Aureus. S. aureus (which I will just call staph) is a bacteria commonly found on a lot of people’s skin and inside the nose (25-30% healthy people). Some Staph types weren’t responding to the antibiotic penicillin, so methicillin was developed to kill these resistant forms of staph in 1959. But MRSA is a sneaky bacterium and started to be resistant against methicillin by the early 1960’s – thereby earning the name MRSA (pronounced Mer-sa). About 1-2% people carry MRSA on their skin or in the nose. In 2005, MRSA was responsible for 94,000 life-threatening infections and 19,000 deaths in USA.

There are 2 types of MRSA: hospital associated (HA) and community-associated (CA) depending on the genetic makeup of the MRSA. But HA vs CA MRSA are now intertwining, so you can see each of them in the “wrong” setting – so some MRSA in the hospital are actually CA-MRSA and some community folks will have Ha-MRSA. 85% of infections are HA and 15% are CA

MRSA isn’t usually a problem and a lot of people probably have it but aren’t aware of it – because who gets routinely tested for MRSA? Almost nobody except those in a hospital or nursing home. So MRSA generally doesn’t cause trouble unless it enters the body through broken skin.

Those at risk for MRSA are those in the hospital and healthcare facilities, especially for those with prolonged hospital stays. Those who receive multiple antibiotics are also at risk for carrying MRSA. Other risk factors: overweight, cosmetic body shaving, skin trauma, lineman or linebacker position in football, prisoner, military, tattoo receipients, illicit drug use, having multiple health problems, and previous antibiotic use. And MRSA can be spread by direct contract with skin, clothes, linens, athletic equipment, hot tub or sauna benches. That is why in a hospital you have to “gown up” if a person is isolated for MRSA – so you don’t carry it and spread it around. MRSA likes to like in warm moist places, like the nostrils, navel, underarms, and groin.

Clinical: Colonization means the person carries MRSA on the skin or in the nose – but there is no infection. Infection means the MRSA is inside the skin or inside the body and causing harm. For hospitalized patients who acquire MRSA, 10-30% will have a problem with infection during or after their hospital stay. So found example after surgery a wound can not heal well due to MRSA infection. Skin infections from bed sores or needles can occur. UTIs especially those with a Foley catheter. If the skin becomes infected (such as a scrape occurs so the MRSA can enter), an abscess can form – which is a pocket of pus. The abscess usually is red, warm, tender, swollen – also called a boil. If the MRSA gets into the blood stream, it can infect internal organs like the lungs, bone, bladder, and brain. A fever is common when MRSA enters the blood stream. CA-MRSA has been known to cause necrotizing pneumonia, necrotizing fasciitis, and endocarditis (heart valve infection) are examples of MRSA infection.

Treatment: In general, CA-MRSA is easier to treat with antibiotics than HA-MRSA. So CA-MRSA often will be susceptible to Bactrim and Clindamycin while HA-MRSA won’t. For those with MRSA in the blood, IV antibiotics are often used. For the skin, the doctor can do an I&D (incision and drainage) of the abscess because oral antibiotics will not enter a pocket of pus well. So it has to be drained and then cleaned well until it heals. We do not treat colonization, but washes well in time can get rid of it.

Prevention: as always – wash your hands, tend any wounds well, stay out of contact with someone you know has MRSA, don’t share personal items (like athletic equipment, bathroom items), don’t demand for antibiotics for viral infections like the cold, and if you do take antibiotics make sure you finish your course so you don’t develop resistance. Alcohol-based hand sanitizers can work if hands are not visibly soiled.

Unfortunately a 17 year old Virginian boy died 10/15/07 of MRSA, though I do not have the details so I don’t know how he got MRSA inside of his body to lead to multi-organ infection. It is a very sad story.

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