Staphylococcus Infection - Essay Example

?Staphylococcus Infection This essay is concerned with staphylococcal infections, in particular those caused by staphylococcus aureus, focusing in particular on urinary tract infections. Included are descriptions of the bacteria, risk factors, treatment and avoidance and control. Also mentioned are the newer, drug resistant strains and the global implications of these. Introduction The bacteria of staphylococcus aureus, one of about 30 different staphylococcal types which can cause human infections, are gram positive, spherical and gather in clusters. They are golden yellow in color and non-motile, tending to form clumps rather like small bunches of grapes. Any testing of material from the human nose, other mucus membrane or skin, especially near the genital and anal areas, is highly likely to be positive for the presence of staphylococcus aureus. MRS, first identified in 1994 and traced back to pigs ( according to Gonzalez, 2011) is also in this group of bacteria , but is much less prevalent, being present in only 1% of people according to Ostrosky-Zeichner ( 2009) In the case of staphylococcus aureus an American survey found its presence in 29% of the American population in 2003-2004 (Kuehnert et al 2006). Bobak in 2009 came up with a very similar figure of 25%. It is when the bacteria reach other places that problems begin and so it should always be considered as a possible pathogen. Often it enters the body through a break in the skin, thus overcoming the body’s own natural defense systems, but this is not always the case. Marrie et al (1982) found the bacteria as part of the normal flora in the urethras of 6% of normal, healthy women. According to Boyce ( 1996) those who have the bacteria already somewhere on their body are more likely to develop Staphyloccal based infections. Staphylococcus Infection Figure 1 Gram stained staphylococcus bacteria in pus When staphylococcus infection occurs it can come in several forms e.g. skin infections such as boils, furuncles and styes. The same bacteria can cause deep seated infections attacking the bones or the myocardium, and it can cause very serious conditions such as meningitis, urinary tract infections and pneumonia. For the purposes of this essay mainly one of these, urinary tract infection. This is much commoner in women than in men simply for anatomically reasons, although there is an increased risk in those who participate in rectal sex. There are a number of other at risk factors outlined on the WebMed website ( 2005). These include the presence of renal calculi, being pregnant, using an intrauterine contraceptive device, use of a catheter and having any condition which affects the nerve supply to the bladder such as diabetes and multiple sclerosis. It is also more likely to be a problem in old age when the body’s immune system becomes weaker. Muder et al ( 2006) found that among veterans in care who had staphylococcal urinary infections 82% had recently been catheterised. The American National Kidney and Urologic Disease Information Clearinghouse (NKUDIC) report that in the United States urinary tract infections account for 8.3 million visits to doctors in a year, so this is a very prevalent condition. Although Escherichia Coli , normally found in the intestine, is the commonest cause of urinary tract infection, other bacteria , including staphylococcus aureus, can cause such infections. Muder et al ( 2006) discuss how the infection can spread to become staphylococcal bacteraemia. Grandsen et al ( 1984) found it to be the causative organism in 17.5% of cases of bacteraemia in one hospital over a period of 14 years with a resultant 50% mortality rate, which underlines the possible seriousness of this condition, especially when one considers that , even then , the authors believed that 60% of these infections were acquired during the patient’s stay in the hospital. They state that when it came to treatment :- Microbiologists seldom influenced directly the choice of initial antibiotic treatment (though this usually conformed to the hospital's antibiotic prescribing policy) but had considerable influence over definitive treatment. Treatment of Staphylococcus Infection As Bobak (2009) states staphylococcal infections can vary considerably from a simple skin infection which results in a boil forming to the much more serious treatment resistant an d life threatening MRSA. (Methicillin-resistant Staphylococcus Aureus). This variability of course means that treatment regimens will also need to vary. Since the discovery of antibiotics, especially penicillin, and their anti-bacterial properties they have been used to treat known staphylococcal infections. Over time however there has been a gradual change in how effective various antibiotics are in these cases. Since the1980’s Penicillin is no longer the effective treatment of choice and newer, stronger antibiotics are needed. However as Bobak ( 2009) points out , in too many cases even these more powerful drugs are failing to overcome the bacteria. First of all though the cause of the infection has to be isolated, which can be done relatively easily by taking a urine sample, preferably a mid-stream specimen, and finding the bacteria therein under the microscope, distinguishing bacterial strains using multi-locus sequence typing. Lloyd however ( 2011) describes how different strains of ST398 cannot be distinguished in this way , although other methods are possible. The bacteria will then be tested against various antibiotics and the patient treated, usually orally , with the relevant drug. Bacteria become resistant for a number of reasons. One could be that, as symptoms decline in severity, people simply stop taking the medication. Another could be that practitioners do not prescribe an adequate dosage. The symptoms lessen, but an acute episode becomes a weaker, long term problem, or returns again as another acute episode. In the case of urinary tract infections other actions help e.g. increasing fluid intake so that bacteria get flushed out or are so dilute that symptoms lessen. Another possible option, if renal calculi are present, is to remove these, perhaps simply by using a smooth muscle relaxant so that the person can expel them, if they are very small. In some cases if the infection goes deep into muscular tissue then it is necessary for it to be thoroughly cleaned under aseptic conditions. Avoiding Staphylococcal Infections and Restricting Their Spread. In hospitals and care situations the disease will not be passed on if such things as proper and adequate hand washing techniques are used and procedures such as catheter care and the care of the cord in neonates is carried out according to agreed protocols. In any situation a cut or sore is a potential way in for infection and so should be cleaned and then covered. The Staphylococcus bacteria can be transmitted via surfaces, whether from dirty hands or via such things as raw meat. It is therefore necessary to instil in children from a young age the need to wash their hands after using the toilet , before eating etc, cleaning the rectal area properly after voiding a stool etc. This very common, but potentially lethal bacteria, can live in body creases or under finger nails etc, so excellent personal hygiene is a must, both in the home, but also among medical care staff. In hospitals and other medical situations there needs to be a definitive antibiotic prescribing policy, arrived at in consultation with microbiologists as well as those who prescribe drugs. Such policies need to be regularly reviewed in view of cases that have occurred and their response to various antibiotics. All staff must be trained in hygienic techniques, whether in carrying out particular procedures such as setting up intra venous infusions, or simply doing basic care of patients. The Future Lloyd (2011) quotes Price, speaking at a recent conference, who describes how , in Denmark and the Netherlands, rates of human infection s from staph organisms , in particular MRSA ST398, is rising considerably and could be described as being the beginning of an epidemic. This particular infection is especially dangerous as its means of transmission remains unknown at present, although it has been found to be present in both pigs and farmers, almost certainly as a result of the automatic use of antibiotics to promote health. These killed off some bacteria , but resulted in the development of resistant strains. We don’t all live on pig farms, but with such a potential risk it is important that even the smallest staph infection is dealt with properly, but even more important that all possible is done to prevent such infections occurring in the first place, or the world will return to its pre-1940’s situation i.e. without helpful antibiotic solutions to possibly fatal staphylococcal infections. References Bobak, A. ( June 2009) What is a Staph infection ? Boots WebMed, retrieved 18th October 2011 http://www.webmd.boots.com/skin-problems-and-treatments/staph-infection-cellulitis Boyce, J. ( 1996) Preventing Staphylococcal Infections by Eradicating Nasal Carriage of Staphylococcus Aureus: Proceeding with Caution, Infection Control and Hospital Epidemiology, Volume 17 , number 12, page 775 Gransen,W., Eyken,S.,Phillip, I., ( 1984) Staphylococcus aureus bacteraemia: 400 episodes in St Thomas's Hospital, retrieved 19th October 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444067/ Kuehnert M., Kruszon-Moran D, Hill H., McQuillan G, McAllister S., Fosheim G, McDougal L., Chaitram J, Jensen B, Fridkin S., Killgore G, Tenover F., ( 2006) Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002, The Journal of Infectious Diseases, January 15th 193(2), pages 172-179, retrieved 18th October 2011 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16362880&ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Lloyd, R,( October 16th 2011) Drug Resistant Staph Infections in Europe Could Mark Start of a New Epidemic, Scientific American, retrieved 19th October 2011, http://blogs.scientificamerican.com/observations/2011/10/16/drug-resistant-staph-infections-in-europe-could-mark-start-of-a-new-epidemic/ Marrie, T., Kwan,C. Noble,M., West,A., and Duffield,L.,( September 1982) Staphylococcus saprophyticus as a cause of urinary tract infections., Journal of Clinical Microbiology (16(3) pages 427-431, retrieved 18th October 2011 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC272384/ Muder R, Brennen C, Rihs J, Wagener M, Obman A, Stout J, Yu V., (January 2006) Isolation of Staphylococcus aureus from the urinary tract: association of isolation with symptomatic urinary tract infection and subsequent staphylococcal bacteraemia,. Clinical Infectious Diseases, 42(1), pages 46-50, retrieved 18th October 2011, http://www.ncbi.nlm.nih.gov/pubmed/16323090 Ostrosky-Zeichner,L., ( 2009) What is a staph infection? Boots WebMed, retrieved 19th October 2011 http://www.webmd.boots.com/skin-problems-and-treatments/staph-infection-cellulitis Todar, K.,( 2008) Staphylococcus Aureus and Staphylococcal Disease, Figure 1 , Todar’s Online Textbook of Bacteriology, Staphylococcus bacteria in pus, retrieved 18th October 2011 http://www.textbookofbacteriology.net/staph.html Understanding Urinary Tract Infections – the Basics, 2005, WebMed, retrieved 18th October 2011 http://www.webmd.com/a-to-z-guides/understanding-urinary-tract-infections-basics Read More