M R S A Methicillin-Resistant Staphylococcus aureus The Facts Michael Parry, M.D. Director of Infectious Diseases and Microbiology Stamford Hospital January 24, 2008
Introduction to Staph aureus Staphylococcus aureus (S. aureus) is a common bacteria that has been around for a long time "MRSA" stands for methicillin-resistant S. aureus Methicillin is a type of antibiotic similar to penicillin Staph aureus can cause multiple types of infections INVASIVE (sterile sites), such as bloodstream infections, spinal fluid (meningitis), joint fluid (arthritis), pneumonia NON-INVASIVE: skin infections (rashes, pus-filled boils, abscesses)
Source of S. aureus Infections Healthcare-associated (hospital, nursing home) Usually invasive (e.g. blood stream infections) Harder to treat (resistant to more antibiotics Community-associated Usually non-invasive Typically skin infections Easier to treat (resistant to less antibiotics)
Hospital-associated MRSA Infections A problem since the 1960s ~60% of S. aureus infections in hospital intensive care units are MRSA Associated with: Greater lengths of stay Higher risk of complications (morbidity) and death (mortality) Increased cost of treatment
Community-associated MRSA Infections First reported in 1980, increased since 1999 Seen in children and young adults, athletes in contact sport, prisoners, men who have sex with men, people who use IV drugs Associated with: Skin infections in vast majority; rarely pneumonia, bloodstream infection, or death Different genetic make-up from hospitalassociated MRSA More antibiotics available for treatment
Invasive MRSA (JAMA October, 2007) In 2005, caused: More than 94,000 life-threatening infections 19,000 deaths 85% of all invasive MRSA infections associated with health care settings (hospitals and nursing homes) 15% community associated No documented health care risk factors Significant public health problem
MRSA Myths New threat never been seen before FALSE MRSA is a death sentence (or severe disability) FALSE People with MRSA people are a threat to everyone FALSE Untreatable by antibiotics FALSE
MRSA Facts MRSA is Preventable While MRSA may not be treatable with methicillin, it is Treatable with other antibiotics 1/4 to 1/3 of all people have S. aureus on their skin and most will never get sick 1% of all people have MRSA on their skin and most will never get sick
Outbreaks of MRSA in the Community Often first detected as clusters of abscesses or spider bites Various settings Sports participants Military recruits Daycare attendees
Outbreaks of MRSA in the Community Various other settings Inmates in correctional facilities Men who have sex with men Tattoo recipients Hurricane evacuees in shelters Nursing mothers
Factors that Facilitate Community Transmission Crowding Frequent Contact Antibiotic Use Compromised Skin Contaminated Surfaces and Shared Items Cleanliness
Prevention Hand washing with soap and water (20 sec.) Before eating After every visit to the bathroom As often as possible Use alcohol-based hand sanitizers when soap and water are not available Cover any open cuts or wounds Avoid sharing towels, razors, uniforms and athletic equipment Shower or bathe with soap and water after a workout, exercise, or strenuous physical activity Wash gym / other clothes after every use
Prevention See a doctor or nurse if you develop an infection or a boil on the skin Early signs of a skin infection: Redness Warmth Swelling Tenderness A pimple that continues to grow Pus coming from a wound or cut Fever
Prevention When MRSA is diagnosed it is not necessary to: Exclude persons from school, work, or sports unless they are unable to keep the infected skin covered with a clean, dry bandage and maintain good personal hygiene Close schools to disinfect them when MRSA infections occur Closing schools for cleaning not usually recommended for MRSA Cleaning should focus on areas likely to come in contact with poorly covered or uncovered skin infections Household bleach may be used for general cleaning: ¼ cup bleach to 1 gallon of water Many other products are effective against MRSA
Treatment Not every skin infection requires antibiotics Many skin infections can be treated with drainage alone More than half a dozen antibiotics are available to effectively treat MRSA Bactrim, tetracyclines, Cleocin, Zyvox ; Bactroban The physician's choice of antibiotic will depend on the strain of MRSA identified Skin cleansing / showering with Hibiclens or phisohex. Bleach baths
Vigilance Parents/Guardians and Students need to: Make sure all cuts and wounds are bandaged or covered up Seek medical care if a skin infection is suspected If treatment is given by a doctor or nurse, continue to monitor the site of infection to make sure it is getting better (if it isn t, seek additional medical attention) Teachers, Coaches, Administrators should do the following: Educate Parents/Guardians, Students and Staff Assure that children diagnosed with MRSA infections avoid activities that cause bandages to come loose and risk skin-to-skin contact Make sure athletic equipment is cleaned after every use
Help Centers for Disease Control and Protection (The "CDC") http://www.cdc.gov/ Connecticut Department of Public Health http://www.ct.gov/dph Disinfectants effective for MRSA http://epa.gov/oppad001/chemregindex.htm Useful documents on MRSA http://www.tpchd.org/page.php?id=12 Stamford Hospital http://www.stamhealth.org/services/infectiousdisease.aspx Acknowledgement: material adapted from multiple sources, including CDC and CT Department of Health.