Download Methicillin-Resistant Staphylococcus Aureus (MRSA)

Kayla Asche
Human Diseases 1
Methicillin-Resistant Staphylococcus Aureus
Methicillin-Resistant Staphylococcus Aureus (MRSA) is a bacteria that is resistant to
antibiotics that are commonly used to treat ordinary staph infections. This infection usually
affects the elderly and those with other disease conditions. MRSA occurs mostly in hospitals,
nursing homes, and other health care settings. In these types of settings, it’s known as health
care-associated MRSA, and typically are associated with invasive procedures or devices such as
surgeries, intravenous tubing, or artificial joints. MRSA is also seen in healthy individuals who
share personal items such as athletes or students, more specifically wrestlers, childcare workers,
those who use locker rooms, and people who live in crowded conditions. This is known as
community-associated MRSA and often begins as a painful skin boil which is spread by skin-toskin contact (Neighbors & Tannehill-Jones, 2010) (MayoClinic, 2012).
The S. aureus bacteria is commonly found on the skin of individuals and does not cause
illness. CDC states that, “While 25% to 30% of people are colonized in the nose with staph, less
than 2% are colonized with MRSA,” (CDC, 2010). Colonized means that a person carries the
bacteria but shows no signs and can easily pass the bacteria on to someone else. In one study
done, they found that MRSA is most likely to reside in the nostrils. This study tested positive
colonizations and used 12,889 admissions. Out of these, they found 298 that were positive and
concluded that the nose was most likely positive with 72.5%, followed by perineum at 39.1%,
throat at 37.7%, and axilla at 8.4%, (John Jr., 2012).
Once MRSA is passed onto someone, they might have trouble fighting it off because
MRSA is a group of bacteria that have developed a resistance to antibiotics to stay alive.
Unfortunately humans have done nothing but make this situation worse and helped by building
this resistance through excessive and unnecessary use of antibiotics. Even when these antibiotics
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Human Diseases 2
are used properly, they don’t always kill every kind of bacteria and those that survive become
resistant to that antibiotic. The bacteria reproduces quickly and builds up family resistance,
meaning that there’s a large amount of bacteria in the body resistant to that drug. Prescription
medication plays a major role in this buildup of resistance, but another aspect is livestock.
Antibiotics are often used in livestock which can end up in meat products and the groundwater
supply from feedlot runoff which we consume (Neighbors & Tannehill-Jones, 2010). Since
MRSA is getting more and more difficult to treat, it is important to know the symptoms so that
you can catch it early and treat it sooner.
Similar to other staph infections, MRSA often starts with small red bumps that resemble
pimples or boils and can quickly cause deep abscesses or become blood-borne. If it becomes a
blood-borne infection then the bacteria can invade body organs such as bones, heart, and lungs
(Neighbors & Tannehill-Jones, 2010). With severe infection such as these, or surgical site
infections and pneumonia, symptoms will vary depending on the type and stage of the infection.
With skin infections, they often first look like spider bites or bumps that are red, swollen, and
painful and commonly occur at sites of visible skin trauma and areas of the body covered by hair
(CDC, 2010).
Diagnosing MRSA is done through cultures and drug sensitivity testing of wounds and
nasal secretions to check for the bacteria. Once infected with this bacteria, treatment options vary
greatly depending on the type, location, and stage of infection. The treatments would include
incision and draining the infected area followed by coverage, antibiotic treatments which
depends on the susceptibility of the bacteria, and possibly surgical or antimicrobial interventions
(CDC, 2010). An antibiotic that is currently being used is vancomycin which is given
intravenously. This drug is currently effective but is already starting to show that some MRSA
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bacteria are building up resistance toward it (Neighbors & Tannehill-Jones, 2010). Since
vancomycin is not as effective and won’t be effective soon, there has been much research done
to find other antibiotics that are effective. One treatment method that has been studied are lysins
from the virus bacteriophages. Bacteriophages are viruses that infect and kill bacteria and the
lysins are enzymes of bacteriophage origin which induce a rapid decline of the bacterial cell,
both of which will combat MRSA (Borysowski et al., 2011).
Health professionals need to know how to treat MRSA and have different options
depending on the various cases. Important guidelines were set in 2011 by an Expert Panel of the
Infectious Diseases Society of America (IDSA). These are evidence-based guidelines for the
management of patients with MRSA and are intended for use by health care providers who care
for patients with MRSA infections. These guidelines discuss the management of a variety of
clinical syndromes associated with MRSA disease which include skin and soft tissue infections,
bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system
infections. Recommendations are also provided regarding the antibiotic drug, vancomycin, it’s
dosing and monitoring, the management of infections due to MRSA with reduced susceptibility
to vancomycin, and vancomycin treatment failures (Liu et al., 2011). When health professionals
use these guidelines, it is important to realize and account for the individual differences among
patients and “the IDSA considers adherence to these guidelines to be voluntary, with the ultimate
determination regarding their application to be made by the physician in the light of each
patient's individual circumstances,” (Liu et al., 2011). These guidelines can be found on this site:
http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full.
Since MRSA is so difficult to treat, prevention measures need to be taken and are key to
avoid contracting this infection. Prevention can be taken on an individual level and also a public
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Human Diseases 4
level. For individuals, it is very important to wash your hands, keep wounds clean and covered,
keep personal items personal, shower after athletic games or practices, and sanitize linens
(MayoClinic, 2012). As a community there are also many prevention measures that should be
taken. This is especially important in areas where MRSA is common such as health care
facilities. For these types of public places, complete sanitation of all surface areas, fabrics,
linens, and equipment is required. Alcohol has proven to be effective in sanitizing against MRSA
and many health care facilities have installed alcohol based skin sanitizers throughout the
facility. Other important practices include frequent hand washing by all staff, testing all patients
upon admission, and placing all patients in isolation until the culture results come back negative,
and sanitation of facility has occurred (Neighbors & Tannehill-Jones, 2010). These preventative
measures can be implemented in all public areas throughout the community.
According to CDC, reducing MRSA in both healthcare and community settings continues
to be a high priority. CDC states that “the agency is engaged in several short- and long-term
surveillance (infection tracking) projects that involve collaboration with partners including health
departments, individual hospitals, and academic medical centers, among others,” (2011).
Understanding the burden of MRSA, how much it is occurring, where it is happening, and how it
is being spread will be beneficial in developing effective prevention programs and measuring
their impact (CDC, 2011). In 2010, a CDC study showed that life-threatening MRSA infections
in healthcare settings were declining and infections that began in hospitals declined 28% from
2005 through 2008. The study also showed a 17% drop in life-threatening MRSA infections that
were diagnosed before hospital admissions, which would be community onset, in people with
recent exposures to healthcare settings, (CDC, 2011).
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These studies provide evidence that rates of invasive MRSA infections in the United
States are falling. CDC states that, “while MRSA remains an important public health problem
and more remains to be done to further decrease risks of developing these infections, this
decrease in healthcare-associated MRSA infections is encouraging,” (2011). Unfortunately the
rates of community-associated infections increased rapidly during the past decade and there is
little evidence that community-associated MRSA is following the same downward trend as
healthcare-associated infections, but CDC is working on strategies to prevent MRSA in the
community.
Works Cited
Borysowski, J., Łobocka, M., Międzybrodzki, R., Weber-Dąbrowska, B., & G&oacutelrski, A.
(2011). Potential of Bacteriophages and Their Lysins in the Treatment of MRSA.
Biodrugs, 25(6), 347-355.
John Jr., J. F. (2012). Nasal site MRSA surveillance may miss colonization. Infectious Disease
Alert, 31(12), 138-139.
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Liu, C., Bayer, A., Cosgrove, S., Daum, R., Fridkin, S., Gorwitz, R., Kaplan, S., & et al. (2011,
January 4). Clinical practice guidelines by the infectious diseases society of america
for the treatment of methicillin-resistant staphylococcus aureus infections in adults and
children. Oxford Journals. Retrieved from
http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full
Mayo Clinic staff. (November 13, 2012). MRSA infection. In MayoClinic. Retrieved April 30,
2013, from http://www.mayoclinic.com/health/mrsa/DS007
Neighbors, M., & Tannehill-Jones, R. (2010). Human diseases. (3 ed.). Delmar Pub.
undefined. (April 15, 2011). Methicillin-resistant staphylococcus aureus (MRSA) infections. In
CDC. Retrieved April 30, 2013, from http://www.cdc.gov/mrsa/index.html.