MRSA: THE STAPHYLOCOCCUS SUPERBUG
Keeping an eye on a drug-resistant bacteria
BY:MARGERY STEIN
What is it?
A type of bacteria frequently acquired by hospital patients, notes Dr. Steven F. Harwin, MD, FACS of Beth Israel Medical Center in New York City, is MRSA, or methicillin-resistant Staphylococcus aureus, a common organism that attacks those with lowered resistance such as postoperative patients.
According to a 2007 report in Emerging Infectious Diseases,a publication of the federal Centers for Disease Control and Prevention (CDC), the number of MRSA infections in hospitals has doubled nationwide, from approximately 127,000 in 1999 to 278,000 in 2005 [the latest year for which government figures are available], while at the same time, deaths increased from 11,000 to more than 17,000. MRSA usually causes skin infections like boils and abscesses that can be fatal.
Symptoms
The CDC explains that "staph bacteria, including MRSA, cancause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections."
Who's at risk?
The Mayo Clinic cites the following as risk factors for health care-associated MRSA (HA-MRSA):
A current or recent hospitalization. MRSA remains a concern in hospitals, where it can attack those most vulnerable older adults and people with weakened immune systems, burns, surgical wounds or serious underlying health problems. This is particularly true if you have a hospital stay of more than 14 days. A 2007 report from the Association for Professionals in Infection Control and Epidemiology estimated that 46 out of every 1,000 people hospitalized are infected or colonized with MRSA.
Living in a long-term care facility. MRSA is also prevalent in these facilities. Carriers of MRSA have the ability to spread it, even if they're not sick themselves.
Invasive devices. People who are on dialysis, are catheterized, or have feeding tubes or other invasive devices are at higher risk.
Recent antibiotic use. Treatment with fluoroquinolones (ciprofloxacin, ofloxacinor levofloxacin) or cephalosporin antibiotics can increase the risk of HA-MRSA.
A note on community-associated MRSA (CA-MRSA)
Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities, notes the CDC. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters)are know as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people. Typically, those at risk include the young, athletes involved in contact sports, those with weakened immune systems and people living in crowded or unsanitary condition, among others.
Prevention
According to the Mayo Clinic, "hospitals are fighting back against MRSA infection by using surveillance systems that track bacterial outbreaks and by investigating products such as antibiotic-coated catheters and gloves that release disinfectants.
Still, the best way to prevent the spread of germs is for health care workers to wash their hands frequently, to properly disinfect hospital surfaces and to take other precautions, such as wearing gowns and gloves when working with people infected with resistant bacteria.
In the hospital, people who are infected or colonized with MRSA are placed in isolation to prevent the spread of MRSA. Visitors and healthcare workers caring for people in isolation may be required to wear protective garments and must follow strict hand-washing procedures."
Treatment
If infection does occur, the Mayo Clinic notes that "both hospital- and community-associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors often rely on the antibiotic vancomycin to treat resistant germs. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains. Although vancomycin saves lives, it may become less effective as well. Some hospitals are already seeing strains of MRSA that are less easily killed by vancomycin."
However, the CDC adds that "many staph skin infections maybe treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider."