Infections

MRSA Infection Information

The University of Connecticut Health Center has established a Collaborative Center for Clinical Care Improvement. The center is dedicated to identifying and sharing models to improve medical outcomes. Based on trends in infectious disease, we thought this brief update about methicillin-resistant Staphylococcus aureus (MRSA) might be of interest.

Background

Over the past two years, we have seen an increasing incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In the 1970’s, 80’s and 90’s, infections with this bacteria were seen almost exclusively in severely ill, hospitalized patients. In fact, most of these infections were “hospital-acquired”; they were frequently responsible for serious postoperative wound infections and pneumonias, and were associated with significant morbidity and mortality.

Now, more and more infections with MRSA are occurring in the community…in patients from skilled nursing facilities, in people who had suffered relatively minor traumas, in individuals without any severe underlying diseases, as well as in very healthy, young athletes. In fact, in our microbiology laboratory, approximately 40 percent of the isolates of Staphylococcus aureus that come from patients residing in the community are MRSA; this is the same percent of MRSA that is seen in patients hospitalized at John Dempsey Hospital.

The following is a primer to update you about MRSA and how to avoid getting it.

What is MRSA?

Staphylococcus aureus are bacteria that are carried on the skin or in the nose of healthy people. Approximately 25 percent to 30 percent of the population are colonized with these bacteria, but have no actual infection. On the other hand, Staphylococcus aureus can also cause skin infections, such as pimples or boils, that require treatment with beta-lactam antibiotics such as penicillins, like Augmentin, or cephalosporins, like Keflex.

Some Staphylococcus aureus isolates are resistant to these commonly prescribed antibiotics. Our microbiology laboratory tests all isolates of staphylococci for their sensitivity to methicillin, an antibiotic that represents the broad class of beta-lactam antibiotics which are used to treat these infections. MRSA are resistant to all penicillins and cephalosporins. Infections with MRSA require treatment with alternative antibiotics, some of which can only be administered intravenously.

Who gets MRSA infections?

It used to be that MRSA infections were confined to the hospital setting in patients who had weakened immune systems or open wounds. Now, more and more MRSA infections are occurring in persons outside of hospitals and healthcare facilities. Most commonly, MRSA cause skin infections in these patients. However, wounds of any type may be infected with MRSA.

Infections with MRSA cannot be distinguished from infections with methicillin-sensitive Staphylococcus aureus or other bacteria on clinical grounds alone. Sometimes, the only clue that an infection is caused by MRSA is the fact that it does not respond to the initial course of antibiotics, suggesting that it is caused by a resistant organism. These infections should be seen by a healthcare provider who will obtain a culture that is sent to the microbiology laboratory for identification and testing for antibiotic sensitivities. If MRSA is identified, changes in the initial antibiotic therapy might be indicated.

How can you prevent skin infections with staphylococci or MRSA?

It is imperative that we practice good hygiene not only in the hospital setting, but also at home:

• Wash your hands frequently with soap and water or with an alcohol-based hand sanitizer.
• Keep all cuts and scrapes clean and covered with a band aid until healed.
• Avoid contact with other peoples’ cuts, scrapes, wounds or bandages.
• Avoid sharing personal items, such as towels or razors.

If you have a staph or MRSA skin infection what can you do to prevent others from getting infected?

You can limit the spread of staph or MRSA infections by following these recommendations:

• Cover your wound. It is important that all infected skin sites be covered with clean, dry bandages. Pus from these wounds contain micro-organisms that can be passed on to others. Do not let anyone else touch your infected site or your bandages unless they are wearing gloves and wash their hands after contact.
• Wash your hands. You, and anyone who has contact with you, should wash their hands frequently with soap and warm water, or use an alcohol-based hand sanitizer after coming in contact with your infection. Some people who have staphylococcal skin infections carry these organisms in their nose. It is important to wash your hands after any contact with someone who has a staph infection.
• Do not share personal items. Any item that comes in contact with your infected wound can be a source of staphylococci to others. Sheets, towels and clothes that have become soiled should be washed with water and laundry detergent. Drying clothes in a hot dryer rather than air drying also helps kill bacteria on clothes.
• Talk to your doctor. If you have a skin infection, particularly one that is getting worse rather than better, or not improving on routine antibiotic therapy, it is important for you to contact your doctor to make sure that you are not infected with MRSA. Only then can appropriate treatment be prescribed for you.

MRSA is not a problem just at the University of Connecticut Health Center, in Hartford, or even in the State of Connecticut. MRSA is now viewed as a national, even international, problem. It is important that we all are aware of our role in promoting its spread when we do not take proper precautions or wash our hands, either at home or in the hospital. If we all understand the danger of infections with microorganisms like MRSA and take proper precautions, we can help limit their spread.