Methicillin Resistant Staphyloccocus Aureaus - Coursework Example

Methicillin Resistant Staphylococcus Aureus (MRSA) Methicillin-resistant Staphylococcus aureus (MRSA) is a subgroup of Staphylococcus aureus. As the name suggests the MRSA strain is of Staphylococcus aureus resistant to treatment with commonly used antibiotics. On the other hand there are other set of Staphylococcus aureus group which are referred to as methicillin-sensitive Staphylococcus aureus (MSSA) and these can be treated using antibiotics (Royal College of Nursing, 2005). Methicillin-resistant Staphylococcus aureus were first recognized in 1961 in the UK, just an year after the antibiotic methicillin was introduced for treating S. aureus infections. MRSA is resistant to all beta-lactam antibiotics. This includes all penicillins such as amoxicillin and cephalosporins such as keflex (MDH, 2007). It is now several decades since methicillin-resistant Staphylococcus aureus (MRSA) has caused infections in patients with well-described risk factors, which include hospitalization, surgery, residence in chronic care facilities, and injection drug use (Lowy, 1998). In recent times, MRSA has caused infections in patients lacking traditional risk factors for infection with MRSA (Hussain, et al. 2000; Gorak, et al. 1999). And to a greater surprise many of these infections have occurred in the community and have affected children and young adults, and some have been linked with significant morbidity. In United States the first recorded MRSA outbreak occurred at a Boston hospital in 1968. In the subsequent two decades most MRSA infections occurred in persons who had close contact with hospitals or other healthcare settings. However, in United States also MRSA infections are now seen in previously healthy persons who were not associated with the healthcare settings. These persons appear to have acquired their infections in the community, rather than in a healthcare setting (MDH, 2007). At this point of time it is good to understand how these organisms have accrued resistance. Antibiotics resistance happens when the S. aureus bacteria produce an enzyme that breaks down antibiotics. S. aureus bacteria have a unique protein that prevents the antibiotic from killing the bacteria. Methicillin-resistant Staphylococcus aureus is a strain of S. aureus that is resistant to a large number of antibiotics making it difficult to treat because of the limited number of antibiotics available (Canadian Institute of Public Health Inspectors, 2000). As of now there are16 epidemic strains of MRSA have been discovered but two particular strains (clones 15 and 16) are thought to be more infectious than the others. Staphylococcus aureus is an organism that colonizes the skin, particularly the nose, skin folds, hairline, perineum and navel. It is also the most common cause of minor infection in wounds, pimples, boils and impetigo. It can also cause serious conditions such as urinary tract infections, pneumonia and toxic shock syndrome (Canadian Institute of Public Health Inspectors, 2000). In general, it commonly colonizes and survives in these areas without causing infection. However in later stages if it is not taken care off a patient becomes clinically infected as the organism begins to invade the skin or deeper tissues and multiplies. These are most common in hospital settings as individuals tend to be older, sicker and weaker than the general population. People with weak immunes systems are more susceptible to MRSA (Royal College of Nursing, 2005). Transmission of MRSA Traditionally, MRSA infections were only known to have been associated with hospitalization or other healthcare settings and risk factors, but in recent years it is a common infection among people other than these settings. These people appear to have community-associated infections. Hence MRSA infections can be classified into two groups i.e. Community-associated MRSA (CA-MRSA) and Healthcare-associated MRSA (CA-MRSA) (MDH, 2007). In general, staphylococci are common in skin folds, such as the perineum, axillae, and in the anterior nares. They may also colonize around the wounds, for instance in eczema, varicose and decubitus ulcers. MRSA has the same way of spread as the other strains of staphylococcus: endogenous transmission and exogenous transmission. Endogenous transmission occurs when a person with staphylococci spreads the bacteria from one part of their body to another part of his own body. In general the best way to prevent it is by encouraging patients to wash their hands and discourage them from touching wounds, damaged skin or invasive devices. This will minimize the risk of the endogenous spread of organisms. Exogenous transmission occurs when MRSA are transferred from one person to another through direct contact with the skin or via contaminated environments or equipment. It is especially true when skin scales become airborne, for instance during activities such as cleaning up the bed of an infected person or if the affected person is heavily colonized, or has a condition such as eczema which causes skin shedding, it can cause widespread distribution of many skin organisms including MRSA. Hence it becomes important to prevent exogenous spread by washing the hand before and after contact with every patient or potentially contaminated equipment. In the hospital settings it is important to wash hand even after removal of gloves. Besides, it may also be helpful to keep the environment as clean and dry as possible and thorough cleaning and drying of all equipment after use can prevent the infection from spreading (Royal College of Nursing, 2005). Research has still not much of evidence of the hereditary nature of the disease. Though not much of information is present regarding the gender, age and culture in which MRSA is most prevalent, in a multivariate analysis it was found that in black race (prevalence ratio 1.53), female sex (prevalence ratio 1.16) and hospitalization within the previous year (prevalence ratio 0.80) were independently associated with community-acquired MRSA (Reuters, 2006). Diagnosis MRSA is diagnosed as the same way as any S. aureus. Definitive diagnosis of S. aureus infection is made by obtaining a culture from the area of suspected infection. Besides the suspect diagnosis is generally based on patient symptoms and if the physician specifically asks for an evaluation. Treatment Methicillin-resistant Staphylococcus aureus bacteria are known to be resistant to many types of antibiotics. Therefore it is important to first make sure that a culture from the infected area is obtained and through the laboratories can testing find out which antibiotics will work to kill the bacteria. This will ensure that the correct antibiotic is given for treatment of the infection. In some cases the skin infections may not even require treatment, but sometimes if treatment is not administered it can be even life threatening. Sometimes it is required to make incision and drain of the infected site and also give antibiotic treatment. These antibiotics should be taken according to the dose prescribed by the physician as they prescribe depending up on the infection (MDH, 2007). Though in a healthy person MRSA colonization is not usually a serious matter, infection with the organism can be critical to patients with deep wounds or even if the healthy person encounters deep wounds. In patients with intravenous catheters or other foreign-body instrumentation these infection can be deleterious. As a secondary infection in patients with compromised immune systems these can be an added trouble. Just because cystic fibrosis patients are often treated with multiple antibiotics in hospital settings, they are often colonized with MRSA, potentially increasing the rate of life-threatening MRSA pneumonias among them. The risk of cross-colonization has led to amplified use of isolation protocols in the hospital settings among these patients. As a last-resort antibiotic, Vancomycin, is used to kill MRSA but in recent years especially since 1997 several new strains of the bacterium has been found showing resistance to Vancomycin antibiotic also. Those new evolutions of the MRSA bacteria are now termend as Vancomycin Intermediate-resistant Staphylococcus aureus (VISA). Today, MRSA also is a problem in paediatrics (Gray, 2004), including hospital nurseries (Bratu, et al 2005). Centers for Disease Control and Prevention reported in 2006 that MRSA is so widespread that 2.3 million Americans carry the bacteria in their noses without any symptoms. CA-MRSA carriers can infect others, or suddenly become ill themselves if the bacteria burrow past the bodys defenses. Any break in the skins protective barrier -- a razor nick, a scratch, or a wound or even nose picking is capable of MRSA infection (Cool, 2007). In the United States, 95 million carry S. aureus in their noses; of these 2.5 million (2.6% of carriers) carry MRSA (Graham, et al, 2006). A population review conducted in 3 communities in the US showed the annual incidence of CA-MRSA during 2001–2002 to be 18–25.7/100,000; most CA-MRSA isolates were associated with clinically relevant infections, and 23% of patients required hospitalization (Jernigan, et al 2006). In the United States there are reports of outbreaks of MRSA colonization through skin contact in locker rooms and gymnasiums, even among healthy populations, and MRSA causes as many as 20% of Staph aureus infections in populations that use intravenous drugs. MRSA is not just the problem in United States it is a major problem around the world. Worldwide, it is estimated that about 2 billion people carry some form of S. aureus; of these, up to 53 million (2.7% of carriers) are thought to carry MRSA (Keep Kids Healthy, 2003). Prevention and infection control strategies Several studies have shown that alcohol has proven to be an effective topical sanitizer against MRSA. Quaternary ammonium together with alcohol can also be used to increase the duration of the sanitizing action. It is very important to follow proper sanitation methods in the hospital setting as MRSA has the capability to survive on surfaces and fabrics including bed covers, or garments worn by care providers or by the patients. There is a need for complete surface sanitation is necessary to eliminate MRSA in areas where patients are recovering from invasive procedures such as surgeries. Vaporized sanitizers can be used particularly in intensive care and ER units. Conclusion Methicillin-resistant Staphylococcus aureus is a bacteria that causes serious health damage and even life threatening. Though research is still on to find out antibiotics against MRSA, still a lot need to be done in this direction. The best way to prevent the spread of infection is through proper sanitation and care. A healthy person can also accrue this infection form gyms, locker rooms and other common places. Therefore, it is very important to keep these places clean and disinfect frequently. References Bratu S., et al. (2005) Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis. Retrieved on 27 August 2007 from http://www.cdc.gov/ncidod/EID/vol11no06/04-0885.htm Canadian Institute of Public Health Inspectors, (2000) Methicillin Resistant Staphylococcus Aureaus (Mrsa): Information Fact Sheet, Retrieved on 27 August 2007 from http://virox.com/pdf/MRSA_FAQ_sheet.pdf Cool, L.C. (2007) Deadly Superbugs: Full of Life, Readers Digest, August 2007. Gorak, E.J., Yamada S.M. and Brown J.D. (1999) Community-acquired methicillinresistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis; 29:797–800. Graham P, Lin S. and Larson E. (2006). A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med 144 (5): 318-325. Gray, J.W. (2004) MRSA: the problem reaches paediatrics, Archives of Disease in Childhood; 89: 297-298. Hussain, F.M. et al. (2000) Current trends in community- acquired methicillin-resistant Staphylococcus aureus at a tertiary care pediatric facility. Pediatr Infect Dis J; 19:1163–1166. Jernigan JA, Arnold K, Heilpern K, Kainer M, Woods C, Hughes JM (2006) Methicillin-Resistant Staphylococcus aureus as Community Pathogen, Emerg Infect Dis, Vol.12(11) November 2006. Keep Kids Healthy, (2003) MRSA Infections, Retrieved on 27 August 2007 from http://www.keepkidshealthy.com/welcome/infectionsguide/mrsa.html Lowy F.D. (1998) Staphylococcus aureus infections. N Engl J Med; 339: 520–32. MDH, (2007) Methicillin-resistant Staphylococcus aureus (MRSA) Minnesota Department of Health, Retrieved on 27 August 2007 from http://www.health.state.mn.us/ Royal College of Nursing, (2005) Methicillin-resistant Staphylococcus aureus (MRSA): Guidance for nursing staff, Published by Royal College of Nursing, London. Reuters, (2006) Community-Acquired MRSA a Leading Cause of Skin and Soft-Tissue Infections, Ann Intern Med 2006;144:309-325,368-370. Read More