One Tough Little Bugger
Almost two years ago, our daughter Alexandria developed a serious infection. Not knowing how to relieve her pain and crying, my wife and I decided that we needed to take her to the Emergency Room. After a blood culture, we found out that she had contracted MRSA.
What is it? MRSA or Methicillin-Resistant Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. This virulent bacterium is a strain of Staphylococcus aureus that, through the process of natural selection, has developed resistance to certain types of antibiotics, including penicillins, and cephalosporins. Although MRSA isn’t typically more aggressive than a regular strain of staph, the antibiotic resistance makes it more difficult to treat. The majority of staph and MRSA infections occur in hospitals or other health care settings among patients with weakened immune systems. Following a recent trend, our daughter’s case is just one of an increasing number of community based infections.
Statistics: Unfortunately, there is no data showing the total number of people who get MRSA skin infections within the general community. However, the table below gives us an idea of its prevalence in the form of estimated incidence rates of invasive MRSA in dialysis patients. An estimated 10,800 deaths in the U.S. each year are caused by staph, 5,500 of which are linked to MRSA. The economic cost created by hospital-acquired infections including those caused by MRSA is estimated to be as much as $45 billion. The increased incidence of these infections and the longer hospital stays and worse patient outcomes associated with them are the key drivers behind the proliferation of costs. The drastic rise in hospitalizations in the past 15 years has mirrored the increase in antibiotic resistance. With nearly 5% of hospitalized patients contracting an infection, the problem may not be given the attention it deserves.
According to the CDC website, studies show that about one in three people carry staph in their nose, usually without any illness. Also, two in 100 people carry MRSA. Although MRSA is still a major patient threat, a CDC study published in the Journal of the American Medical Association Internal Medicine showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRS infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2005 versus 2011.
What are the signs? Our daughter’s case started in typical fashion with a red bump that looked like a pimple. This lesion quickly became painful and inflamed and ultimately developed into an abscess that required surgical drainage. Infection sites can also resemble a spider bite and can cause serious infections in surgical wounds. Infections such as those caused by MRSA are most dangerous when they get into the bloodstream and bones. Healthy individuals may carry MRSA asymptomatically for periods ranging from a few weeks to many years.
How do I contract it? Risk factors for healthcare-associated MRSA infections (HA-MRSA) include the following:
– Current or recent hospitalization
– Living in a nursing home
– Long-term antibiotic use.
Risk factors for a community-associated (CA) MRSA Infection include:
– Having an underdeveloped or weakened immune system
– Playing contact sports
– Association with healthcare workers (family, friends, etc.)
– Living in crowded or unsanitary conditions.
Diagnosis: In most patients, MRSA can be detected by swabbing the nostrils and isolating the bacteria found inside on an agar plate. Tests such as quantitative PCR, that can detect staph DNA, and latex agglutination can yield faster results than growing the bacteria in a lab.
How is it treated? Both CA- and HA-MRSA are usually treated differently. CA-MRSA typically has a greater spectrum of antimicrobial susceptibility including sulfa drugs, tetracyclines, and clindamycin. HA-MRSA can be resistant to these antibiotics and often is susceptible to only vancomycin. A bit disconcerting is the fact that there are several newly discovered strains of MRSA that show antibiotic resistance to vancomycin and can only be treated with more powerful antibiotics.
How can I prevent infection? Similar to other infections, hands should be washed often with warm water and soap or with an alcohol-based hand sanitizer. Open wounds should be covered and kept clean and sharing personal hygiene items such as towels, sheets, clothing, and toiletries should be avoided. Small children or infants still in diapers have underdeveloped immune systems. Due to this, care should be taken to wash or sterilize your hands before and after changing them. Finally, surfaces can be sanitized using alcohol or a mixture of ammonium and alcohol which can extend the longevity of the sanitation. Combined with these sanitary measures, screening patients admitted to hospitals has also been found to be effective at stopping the spread of MRSA. In addition to personal preventive measures, each state offers HAI (Healthcare Acquired Infection) Prevention Activities. Please visit the following website to see what’s available in your area.