The skin is the body’s first defense against infection. When breached, bacteria can invade the body, potentially causing infection. Sometimes these infections are made more difficult to treat if the bacteria develop resistance to available treatments. Such resistant strains are a growing challenge to medicine. One such strain is “methicillin-resistant Staphylococcus aureus,” better known as “MRSA.”

About MRSA

MRSA – pronounced “mursa” – is a strain of Staphylococcus aureus (S. aureus) that has developed resistance to the standard treatment for bacterial infection, antibiotics, making it very difficult to treat. The resistant strains have primarily evolved due to rampant overuse of antibiotics in medicine. These then spread rapidly from one person to another through sharing of belongings and establish themselves in the general community. Around one percent of all people are believed to be carriers of the bacterium.

The infections can be acquired in hospitals and healthcare settings or out in the community. The bacteria enter the body through a cut, sore, abrasion, cannula, catheter, or breathing tube, and can cause either a mild localized infection – like a pimple, boil, or sore – or a more serious systemic infection affecting the blood, bones, heart, and lungs.

Risk Factors

Elderly persons with weak immune systems, who remain hospitalized for long durations are at highest risk for hospital acquired (HA)-MRSA. However, a person of any age can be affected. The risk increases when there are any medical devices used in the hospital. These include cannulae (tubes) and catheters inserted into the body through the skin, nose, or urinary tract. A person who is a carrier of MRSA may transmit the infection without having symptoms. A special transmission risk is through the hands of nurses and healthcare personnel who examine several patients consecutively without washing hands after each one.

Community acquired (CA)-MRSA affects the healthy general population and spreads through skin-to-skin contact. People at highest risk are those who live in crowded conditions (like prisons or military barracks), childcare workers, employees of nursing homes, and athletes like wrestlers and football players. Such infections are usually localized and only cause a pimple, boil, pustule, or infected wound.

Symptoms

A localized skin infection due to MRSA may cause a red, swollen, painful, and pus-filled elevation in the skin. There may be fever, and the area may be warm to the touch. Medical help must be sought if pimples, insect bites, cuts, abrasions, wounds, or scrapes, especially in children, are suspected to be infected.

A more serious infection occurs when MRSA invades the bloodstream and spreads to various organs in the body. There may be fever, tiredness, headache, body aches, chills, difficulty in breathing, chest pain, cough, or a skin rash.

Diagnosis

MRSA infections are diagnosed through the growth of cultures. This is a procedure where bacteria are isolated and grown in laboratory conditions from samples collected from patients. The samples usually collected for this include blood, sputum, urine, pus, or a skin swab. The substance collected depends on the location of the infection.

Treatment

As the name implies, this strain of S. aureus is resistant to methicillin, an antibiotic used in the treatment of such infections. If the infection is on the skin, it may be drained by making a surgical incision.

Serious hospital-acquired MRSA infections may require treatment with more powerful antibiotics. These include clindamycin, daptomycin, doxycycline, linezolid, minocycline, tetracycline, trimethoprim-sulfamethoxazole, or vancomycin. These need to be taken in the full prescribed regimen to achieve complete results and prevent newly resistant strains from evolving.

Systemic, life-threatening infections require IV antibiotics and hospitalization. Ventilator support and/or dialysis may be required if the infection involves the lungs or kidneys.

Precautions

In a MRSA skin infection, it is good to keep the infected site covered with a dry, sterile bandage until it heals. Covering the skin wound helps to contain the infection. Avoid using a public swimming pool, common bathing facilities, saunas, spas, and whirlpools till the wound is completely healed. Regularly wash hands, especially after touching the wound. Hand washing is best done with soap and water, though a hand sanitizer of at least 60 percent alcohol may be used.

Any belongings that have been exposed to MRSA should be cleaned and disinfected. The U.S. Environmental Protection Agency (EPA) provides a list of chemicals that can be used for MRSA. Before using any such cleanser, detergent, or disinfectant, the label should be carefully read for instructions for use, to find out how much to apply, and how long to leave the chemical on the surface to be disinfected. Above all, hands should be washed with soap and water after any infected items are handled.

Prevention

MRSA can be prevented with proper procedures. People need to be watchful if hospitalized and know that it is fine to remind healthcare workers to wash their hands. A person may even discuss with them the proper procedures for safely removing catheters and infusion ports. All visitors to the hospital should be requested to wash their hands.

Following discharge from a healthcare facility, be alert for any signs of infection including fever, chills, malaise, or increased soreness around a wound or incision. Medical help should always be sought upon any sign of infection.

To prevent the spread of infection and to keep away from acquiring an infection from others at home or in the community, avoid sharing personal belongings like razors, combs, towels, napkins, linen, utensils, beddings, or clothing. Any sports equipment, if shared, should be cleaned with disinfectants.

In areas where someone has a MRSA infection, the patient’s environment should be kept clean, ventilated, and hygienic. Bed rails, chairs, tables, and other surfaces should be regularly disinfected with proper chemical agents. The personal items of these patients should be handled only after wearing protective gloves. Hands should be washed with soap and water before and after handling any objects soiled with infectious fluids.