MRSA infection

Running Head : MRSA : Methicillin-Resistant Staphylococcus aureus

MRSA

Methicillin-Resistant Staphylococcus aureus

STS 101

Dr . W . Berman

Place

March 20 , 2007

MRSA

Methicillin-Resistant Staphylococcus aureus

Abstract

The article starts with a brief introduction to MRSA along with of Staphylococcus aureus . Next the article describes in brief various causes , risks , symptoms and diagnosis for MRSA infection and preventive care

MRSA Infection

In to understand Methicillin-Resistant Staphylococcus aureus (MRSA , we need to first understand Staphylococcus aureus . According to Patient UK , Staphylococcus aureus is a bacterium found on

the skin and in the nose of healthy people . About 3-10 people are `carriers ' of S aureus being harmless to healthy people , S . aureus infection is caused when a person gets a cut or graze forming boils , pimples , impetigo and skin abscess

The bacterium S . Aureus affects people with an already poor immune system by getting into the blood . Once the bacterium poisons the blood it can causes conditions such as lung infection (pneumonia , bone infection (ostemyelitis ) and heart valve infection (endocaditis . These infections are required to be treated by antibiotics

There are various strains or subtypes of S . aureus of which some are resistant to the antibiotic Methicillin ' and many other antibiotics These strains are called Methicillin Resistant Staphylococcus aureus (MRSA . Strains of MRSA are as aggressive and infectious as any other strains of S . aureus , but are difficult to treat since many antibiotics do not act on them . Infections become severe if causes of infection are not diagnosed at the earliest and resistant antibiotics are administered

Year Percentage of Infections

1974 2

1995 22

2004 63 It seems more probable that existing transmissible strains were selected by antibiotics , and that spread then occurred mainly in the hospitals although there are reports of inter-country spread . The reason for a pandemic at this time remains unknown , but possibly the increased use of cephalosporin 's and other newly available antibiotics may have provided the selective influence . It is also possible that there is an as yet unidentified transmissibility factor . A study by Voss and colleagues of 200 isolates from 43 hospitals in ten European countries in 1994 showed that the frequency of MRSA ranged from less than 1 to 30 the incidence was highest in southern Europe . MRSA increase at alarming rate through out the world let us run short of efficient beta-lactam antibiotics of MRSA infection . S . aureus is an aggressive pathogen and is common cause of infections both in hospitals and in communities . The main reason behind the increase of MRSA infection is untreatable multi-resistant S .aureus infections and also influenza outbreak

MRSA generally affects those who are already ill with wounds or open sores (bed sores ) or burns in a hospital environment . Urinary catheters and tubes leading into veins or body (i .e , drips ) may sometimes be contaminated by MRSA causing urine or blood infection . MRSA infections are less common outside a hospital environment

Symptoms of MRSA infections include reddening of skin and inflammation around the affected areas . Other symptoms include fever , lethargy headache , urinary tract infections , pneumonia , toxic shock syndrome and even death

Mayo clinic stated that small red bumps are deep , painful abscesses requiring surgical draining

According to Mayo clinic , the causes for MRSA infection are

Unnecessary usage of Antibiotic in humans : MRSA is a consequence of excessive and unnecessary antibiotic use

Antibiotics in food and water : Excessive administration of antibiotics to pigs , beef cattle and chickens may finally find their way into municipal water systems , when the runoff from feedlots contaminates streams and groundwater . Antibiotics administered to animals in requisite dosage would avoid the production of resistant bacteria

Germ Mutation : Bacteria live on an evolutionary fast track , so germs that survive treatment with one antibiotic soon learn to resist others ' Bacteria mutate much faster than new drugs are produced ending up being highly resistant

Risk factors for hospital and community strains differ because of the two different settings in which they occur . The risk factors for HA-MRSA are as follows

A Current or recent hospitalization : MRSA is still a matter of concern in hospitals and health care facilities . Since older patients , people with weakened immune system , burns , surgical wounds or serious underlying health problems

Residing in a long-term care facility : MRSA is more prevalent in these facilities and carriers of MRSA are active in such areas

Invasive devices : Patients on dialysis , catherization , feeding tubes or other invasive devices are most vulnerable

According to Centers for Disease Control and Prevention , there has been a rise in proportion of infections that are antimicrobial resistant The percentage of MRSA infections in different years of the infections are as follows Canadian Centre for Occupational Health and Safety (CCOHS ) stated that people with long term illness , intensive users of antibiotics intravenous drug users or immuno-suppressed are at higher risk of being infected by MRSA

MRSA spreads through physical contact and not through air . Contaminated hands of healthcare workers and medical devices contaminated with body fluids containing MRSA are culprits in spreading germ

Centers for Disease Control and Prevention stated that MRSA infection can be of two types namely

Health Care Associated MRSA (HA-MRSA : This type of infection catches up in a health care surrounding such as a hospital , clinic etc

Community Associated MRSA (CA-MRSA : Staph or MRSA infections outside health care facilities or hospitals are called CA-MRSA . Skin infections of CA-MRSA are prevalent in athletes , military recruits , children Pacific Islanders , Alaskan Natives , Native Americans , Homosexuals and prisoners . Various factors are associated with the spread of MRSA skin infections such as close skin-to-skin contact , cuts or abrasions contaminated items and surfaces , crowded living conditions and poor hygiene

Main risk factors for CA-MRSA are as follows

Young Age : Children are most susceptible to CA-MRSA . Once the germ enters through a cut or a scrape , MRSA may cause wide spread infection in children since the immune system of children is not well developed

Participating in contact sports : CA-MRSA may spread among amateur and professional sports teams through cuts and abrasions and skin-to-skin contact

Sharing towels or athletic equipments : CA-MRSA spreads among athletes sharing razors , towels , uniforms or equipment

Weakened immune system : Immunosuppressed people suffer from weakened immune systems and are most likely to have CA-MRSA infections

Living in crowded or unsanitary conditions : CA-MRSA has occurred in military training camps and in American and European prisons

Recent hospitalization or antibiotic use : Recent hospital stay or treatment with medications such as fluoroquinolones (ciprofloxacin ofloxacin or levofloxacin ) or cephalosporin increases the risk of CA-MRSA

Association with health care workers : people in contact with health care workers are at a higher risk of serious staph infections

MRSA is diagnosed by the doctors by checking a sample tissue or nasal secretions for traces of drug resistant bacteria . The samples are sent to a laboratory for culture and tested

Dr . Alan Johnson (2007 ) stated that S . aureus infections are treated with antibiotics such as flucloxacillin (i .e , Floxapen . But this is not effective against MRSA and it is also important to note that MRSA are resistant to antibiotics such as erythromycin and ciprofloxacin However , MRSA can be treated by administering vancomycin through slow infusion into a vein and teicoplanin can also be injected into a muscle or rapid infusion into a vein . Another drug linezolid can also be administered intravenously in severely ill patients . One more drug daptomycin (Cubicin ) has been licensed for the treatment of skin infections including those caused by MRSA

According to Canadian Centre for Occupational Health and Safety (CCOHS prevention of MRSA infections is based on standard infection control measures

Hand washing : Hands must be washed immediately after the gloves are removed after examining the patients

Gloving : Blood , body fluids and contaminated items should not be touched . Gloves should be worn to collect the sample containers

Masking : Masks and face shields must be worn while performing procedures that generate splashes of blood or body fluids

Gowning : Gowns should be worn while performing procedures that generate splashes of blood or body fluids

Patient Care Equipment : Proper cleaning , disinfection and sterilization of all the patient care equipment must be done

Laundry : Appropriate care must be exercised in handling , transportation and cleaning of used linen . Blood and body fluids should be washed and cleaned to avoid skin exposure and transfer of microbes to other patients

In case a patient is judged as a case of special significance the patient should be placed in a separate room under complete isolation

According to Mayo clinic following measures are to be taken to avoid CA-MRSA

Do not share your personal items such as towels , sheets , razors clothing and athletic equipment with others

Wounds must be covered with sterile , clean and dry bandages till they heal

Hands must be washed in or out of hospital

Question 1 . MRSA is a

a . Bacterium b . Virus c . Insect d . Chemical

Question 2 . The poisoning of blood with Staphylococcus aureus is called

a . Endocarditis b . Pneumonia c . Septicemia d . Osteomyelitis

Question 3 . MRSA spreads through

a . Air b . Physical contact c . Water d

Question 4 . MRSA infection can be of

a . One type b . Two types d . Three types e . Four types

Question 5 . Children are more susceptible to

a . Community Associated MRSA (CA-MRSA

b . Health care Associated MRSA (HA-MRSA

c . Cuts , burns , electrical shocks etc

d . of the above

Question 6 . Strains of MRSA are .aggressive and infectious

a . Equally . b . unequally c . not harmful d . Varies from strain to strainConclusion

The mechanisms of antibacterial resistance shown by MRSA are diverse and include all known types of resistance such as target alteration , efflux and permeability changes . In addition a number of these mechanisms can be expressed in single isolates often contained within the same transposon or plasmid . This gives MRSA a huge selective advantage in the hospital setting and allows the spread of multi drug resistance clones from ward to ward . Although strict hospital isolation and infection control procedures have helped in the battle to control MRSA , it is quite clear that we still require new antibacterial agents to treat infections caused by this problem bacterium

References

HYPERLINK "http /www .link .med .ed .ac .uk /ridu /Mrsa .htm http /www .link .med .ed .ac .uk /ridu /Mrsa .htm

HYPERLINK "http /www .cdc .gov /ncidod /dhqp /ar_mrsa .html http /www .cdc .gov /ncidod /dhqp /ar_mrsa .html

HYPERLINK "http /www .mayoclinic .com /health /mrsa /DS00735 http /www .mayoclinic .com /health /mrsa /DS00735

HYPERLINK "http /www .patient .co .uk /showdoc http /www .patient .co .uk /showdoc

HYPERLINK "http /www .netdoctor .co .uk /diseases /facts /mrsa .htm http /www .netdoctor .co .uk /diseases /facts /mrsa .htm

HYPERLINK "http /www .nhsdirect .nhs .uk /articles /article .aspx ?articleId 252 http /www .nhsdirect .nhs .uk /articles /article .aspx ?articleId 252

HYPERLINK "http /www .ccohs .ca /oshanswers /biol_hazards /methicillin .html http /www .ccohs .ca /oshanswers /biol_hazards /methicillin .html

HYPERLINK "http /www .cdc .gov /ncidod /dhqp /ar_MRSA_spotlight_2006 .html http /www .cdc .gov /ncidod /dhqp /ar_MRSA_spotlight_2006 .html

HYPERLINK "http /www .cdc .gov /ncidod /dhqp /ar_mrsa_ca_public .html http /www .cdc .gov /ncidod /dhqp /ar_mrsa_ca_public .html

HYPERLINK "http /www .netdoctor .co .uk /diseases /facts /mrsa .htm http /www .netdoctor .co .uk /diseases /facts /mrsa .htm

HYPERLINK "http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 2 http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 2

HYPERLINK "http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 3 http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 3

HYPERLINK "http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 4 http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 4

HYPERLINK "http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 4 http /www .mayoclinic .com /health /mrsa /DS00735 /DSECTION 8

HYPERLINK "http /www .patient .co .uk /showdoc http /www .patient .co .uk /showdoc

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