Q: Please explain MRSA. Is it part of the staph infection family and how do you get rid of it? How do you get it and why does it keep coming back? Can someone have surgery if they have it? Thank you.
A: MRSA is short for methicillin-resistant staphylococcus aureus infection which is caused by a strain of staph bacteria. This infection does not improve with first-line antibiotics, making it difficult to control. Most cases are found in individuals who have been hospitalized, are in nursing homes, children’s day care centers or in our country’s prison system. There is also community-associated MRSA known as CA-MRSA which is showing up in healthy individuals who have not been hospitalized. CA-MRSA skin infections have been identified in areas where athletes and military recruits share close, less than optimal quarters. The Journal of the American Medical Association published an article on the subject and indicated that while the average age of people with MRSA in a hospital or health care facility setting at the time of the survey was 68, the average of an individual with CA-MRSA was only 23. Regardless of age, the condition is difficult to treat because of its resistance to those antibiotics most frequently used. The symptoms that present will depend on where a person is infected. Most frequently, MRSA causes skin infections but it can also affect surgical wounds, the lungs, and urinary tract.
Infection is spread by contact such as by touching an object that has the bacteria on it or through nasal droplets. MRSA is now resistant to methicillin, penicillin, oxacillin, amoxicillin, as well as to good second-line antibiotics docycycline, Bactrim and vancomycin. The condition may exacerbate within 24 to 48 hours of initial typical symptoms. It lies dormant in and on the body (commonly in the nose) when not causing an active disease, yet even when dormant, attempts to rid the carrier have generally been unsuccessful. The best treatment for a MRSA abscess is excision and drainage.
Initial symptoms may include what appears to be a spider bite or small red pimples that develop into pus-filled boils. New techniques for diagnosis have been developed. Generally speaking, however, the bacterium must be cultured in one of several possible ways – either through sputum, blood, urine, or through other bodily fluid cultures — all of which take time. This results in a physician likely making a rapid decision and treatment plan based on symptom presentation while waiting for cultures to return from a lab setting.
In 2001 the Centers for Disease Control reported on MRSA in the Los Angeles prison system because of the poor hygiene practices known to occur in confined areas. There was a massive rise in skin and soft tissue infections reported and today there are hundreds of similar reports from other prisons across the country. Because of this, the Federal Bureau of Prisons has released guidelines for management and control. Even athletes have had an increased number of outbreaks contacted in locker rooms and gyms. Three studies done by the Texas Department of Health identified the infection rate among football players was 16 times that of the national average. I could continue to cite cases involving children in day care centers because they are prone to scrapes and scratches, seniors in crowded assisted living facilities, hospitals and more, but the bottom line is that MRSA can be present in any system of life and we must do all we can to keep it under control. The best thing a reader can do, with or without MRSA, is to clean and cover scrapes expeditiously and to use good hygiene practices. Athletes should not share towels or razors and should shower after games and practice sessions. Door handles, water faucets and toilet seats in public areas are common vectors for infection, so remember to wash your hands frequently with an anti-microbial cleanser and take precautions when around anyone so diagnosed.
In terms of surgery, this is a decision best left to your physician. Precautions can be taken beginning several days prior to a surgical case that will reduce the risk of infection at the surgical site. Be guided by what he or she indicates is best.
