Mrsa

Introduction

MRSA is a serious infection that can become life-threatening if left untreated.

Some germs that commonly live on the skin and in the nose are called staphylococcus or "staph" bacteria. Usually staph bacteria don't cause any harm. However, sometimes they get inside the body through a break in the skin and cause an infection. These infections are usually treated with antibiotics. When common antibiotics don't kill the staph bacteria, it means the bacteria have become resistant to those antibiotics. This type of staph is called MRSA (Methicillin-Resistant Staphylococcus Aureus).

Anyone can get MRSA. Infections range from mild to very serious, even life-threatening. MRSA is contagious and can be spread to other people through skin to skin contact. If one person in a family is infected with MRSA, the rest of the family may get it.

MRSA was first identified in the 1960's and was mainly found in hospitals and nursing homes. This occurred because antibiotics were being given to people when they were not needed, and patients were not taking antibiotics as directed. This type of MRSA is referred to as HA-MRSA (Healthcare-Associated MRSA). In the late 1990's, a new type of MRSA was identified. This new type is referred to as CA-MRSA (Community-Associated MRSA). This new type of MRSA is becoming more common among children and adults who do not have medical problems.

Epidemiology

Recent reports of strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from children in the community have led to speculation that the epidemiology of S. aureus is changing. Epidemiologic features of the cases described in these reports show a major departure from features typically associated with MRSA colonization or infection. Traditionally, MRSA infections have been acquired almost exclusively in hospitals, long-term care facilities, or similar institutional settings.

Risk factors for MRSA colonization or infection in the hospital include prior antibiotic exposure, admission to an intensive care unit, surgery, and exposure to an MRSA-colonized patient. Humans are a natural reservoir for S. aureus, and asymptomatic colonization is far more common than infection. Young children tend to have higher colonization rates, probably because of their frequent contact with respiratory secretions.

When cases of MRSA infection have been identified in the community, a thorough investigation usually reveals a history of recent hospitalization; close contact with a person who has been hospitalized; or other risk factors, such as previous antimicrobial-drug therapy. A study from Chicago found a 25-fold increase in the number of children admitted to the hospital with an MRSA infection who lacked an identifiable risk factor for prior colonization.

These reports of infection and colonization by strains of MRSA in children provide compelling evidence that MRSA strains have gained a foothold in the community and are emerging as important outpatient pathogens.1
Etiology, Transmission, and Pathology

Anyone can get MRSA. You can get MRSA the same way you can get a cold, such as by touching someone or something that has the bacteria on it and then touching you eyes or your nose. MRSA can live on surfaces and objects for months.

Some ways that you could get MRSA:
• Touching the infected skin of someone who has MRSA.
• Using personal items of someone who has MRSA, such as towels, wash cloths, clothes or athletic equipment.
• Touching objects, such as public phones or doorknobs, that have MRSA bacteria on the surface.
• Being in crowded places where germs are easily spread, such as hospitals, nursing homes, daycares or college dorms.

You may increase your chances of getting MRSA if:
• You take antibiotics a lot.
• You take antibiotics without a prescription.
• You don't follow directions when taking antibiotics, such as stopping early or missing doses.

You are at greater risk of getting MRSA if you are recovering from surgery or burns, have tubes in your body for medical treatment, or if you share needles.

Symptoms and Signs

Symptoms of a MRSA infection depend on where the infection is. If MRSA is causing an infection in a wound, that area of your skin may be red or tender. If you have a urinary tract infection, you may have fever, back pain, burning when you urinate, or a need to urinate more often than usual. If you have pneumonia, you may develop a cough.

Community-Associated MRSA commonly causes skin infections, such as boils, abscesses, or cellulitis. Often, people think they have been bitten by a spider or insect. Because MRSA infections can become serious in a short amount of time, it is important to see your doctor right away if you notice a boil or other skin problem.

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Diagnosis

You would not usually be tested for MRSA unless you have an active infection. If you have a skin infection your health care provider may take a sample of the fluid. This is called taking a culture. Diagnosis is by Gram stain and culture of infected material. Susceptibility studies should be done because methicillin-resistant organisms are now common and require alternative therapy.
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Prognosis and Treatment

Prevention

Aseptic precautions (eg, thoroughly washing hands between patient examinations and sterilizing shared equipment) help decrease spread in institutions. Strict isolation procedures should be used for patients harboring resistant microbes until their infections have been cured. An asymptomatic nasal carrier need not be isolated unless the strain is MRSA or is the suspected source of an outbreak. Cloxacillin, dicloxacillin, TMP-SMX,
Ciprofloxacin (each of these often combined with rifampin), and topical mupirocin have been useful in treating MRSA in carriers, but the organism recurs in up to 50% and frequently becomes resistant.

Staphylococcal food poisoning can be prevented by proper food preparation. Patients with staphylococcal skin infections should not handle food, and food should be consumed immediately or refrigerated and not kept at room temperature.

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Conclusions

References

1 [http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm]http://www.oppapers.com/essays/Mrsa/117935

Mrsa 8.5 of 10 on the basis of 1384 Review.