Sunday, February 17, 2008

Recognizing the Dangers of MRSA and CAMRSA

Methicillin Resistant Staphylococcus Aureus ("MRSA") is a type of bacteria that occurs naturally in approximately 1 in 4 healthy individuals. In the general population, Staph. Aureus is harmless. It stays mostly in a person's nasal passages or on their skin. Occasionally, the bacteria becomes exceptionally resistant to the antibiotics that would normally work well to stem the tide of infection. When this happens, MRSA becomes increasingly resistant to a particular family of antibiotics called beta-lactams. When resistance occurs, commonly prescribed medications such as Meropenem, which would normally wipe out the infection with ease, are rendered ineffective against MRSA.

MRSA is spread when someone with an active Staph. Aureus infection comes into direct contact with someone who is immuno-supressed. Because of the body's inability to ward off infection, Staph is able to take hold and begin to multiply rapidly. Hospitals are often to blame when a patient contracts MRSA. In the cystic fibrosis community, the MRSA may be acquired through indirect contact with CF patients who are colonized with MRSA; for example their bedding, curtains, doctors' coats, nurses scrubs, etc. Community Acquired-MRSA ("CA-MRSA") infections can cause the same type of infections as other strains of Staph. Studies conducted in Minnesota have found that CA-MRSA is more likely to cause skin and soft tissue infections and that healthcare-associated MRSA is more likely to be found in sputum or urine.

The good news about MRSA is that patients who are colonized do not exhibit deterioration in lung function as a result. Patients who are MRSA-positive will more often than not have MRSA in their sputum, even when they're not experiencing an exacerbation due to infection. Additionally, CA-MRSA bacteria are usually susceptible to more types of antibiotics than are healthcare-associated strains of MRSA.

Recently, a newer, stronger, more resistant strain of Staph. Aureus has been identified by the Centers for Disease Control. CA-MRSA is a huge public health threat.

How Worried Should I Be?

Some people can culture CA-MRSA without ever presenting an infection. This is because staph occurs naturally in the body. The CDC reports that only 1% of the population is infected with CA-MRSA. According to the 2005 Cystic Fibrosis Patient Registry Report, the overall percentage of patients with MRSA is 17%. CF patients between the ages of 11 and 17 had the highest number of occurrences of infection. A likely explanation is that people in that particular demographic are not as fastidious about personal hygiene.

Taking reasonable precautions to prevent infection is always in the best interest of a person with cystic fibrosis. The easiest ways to protect yourself from CA-MRSA are as follows:

1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with a bandage until healed.
3. Avoid contact with other people's wounds or bandages.
4. Avoid sharing personal items such as towels or razors.

Adhering to a strict cross-infection control plan when in the presence of other cystic fibrosis patients is also encouraged. When sitting in the waiting room for a clinic appointment, keep a minimum distance of 3 feet between yourself and others. Always cover your mouth when coughing, or wear gloves and a mask.

The effects of CA-MRSA can be devastating within a short period of time. It has the potential to destroy healthy tissue very rapidly. Cystic fibrosis patients especially should be careful to steer clear of people who are coughing or sneezing repeatedly. It's important not to ignore symptoms that may indicate infection.

Symptoms of CA-MRSA

Some people can be colonized with Staph. Aureus yet never suffer from an infection. In many cases, exposure to MRSA will not result in symptoms of disease for long periods of time. Unlike MRSA, people infected with CA-MRSA will exhibit symptoms almost immediately or within a period of a few days.

Symptoms of MRSA include:

* Abscesses at the site of broken skin
* Pustules or other pockets of pus that resemble boils or pimples
* Redness, pain and swelling at the site of presumed infection

In severe cases, CA-MRSA can manifest as serious infections such as:

* Pneumonia
* difficulty breathing
* fever or chills

It's always best to contact your physician if you or your child exhibits a rapid onset of the above mentioned symptoms.

CA-MRSA at School

Younger children should be instructed of the importance of hand-washing. Teach them to wash with warm water and soap. Singing the alphabet song (30-45 seconds) while washing is a good way for them to remember how long they should rinse. Be sure to tell your child with CF to keep his or her hands to herself on the school bus. Cuts, scrapes, and wounds should be covered with a bandage, and not picked at.

Gym class is where CA-MRSA is most likely to raise its ugly head. Locker rooms and showers are warm, moist environments where bacteria like to thrive. College students who live in crowded dorms should also be careful to limit their exposure to areas where staph may like to grow.

In the world not-restricted by the walls of a classroom, there are other ways to lower your risk of contracting CA-MRSA. Use your knuckles instead of your fingertip when pressing elevator or ATM buttons. Keep a small bottle of hand sanitizer or disinfectant wipes in your purse, briefcase or glove compartment, and use whenever necessary.

How is it Treated?

Most skin infections resolve without treatment. Other infections, however, require incision and drainage or antibiotic treatment to cure the infection. Skin infections that are left untreated can develop into more serious life-threatening infections such as infections of the bone or blood. More serious types of Staph. Aureus infections (such as pneumonia or bloodstream infections) typically require hospitalization and treatment with intravenous antibiotics. Although CA-MRSA and MRSA are difficult to eradicate once a person has become infected, a combination of drugs has demonstrated effectiveness. Vancomycin, or a similar medication can be prescribed. There is a possibility for longer lasting or more severe infections with CA-MRSA if the initial antibiotic prescribed is not capable of killing the bacteria. There is some evidence that preventive therapy with flucloxacillin is useful. Additionally Chloramphenicol and clindamycin tend to have activity against CA-MRSA.


Berky said...

While concerns about MRSA and transmission within school venues is a very real problem, alcohol-based hand sanitizers are being improperly and irresponsibly promoted, as there are alcohol-free products that are safer, more effective and more appropriate. Many school systems are systematically banning alcohol-based hand sanitizers due to product concerns and facility safety issues. Exactly why product such as Soapopoular ( are being introduced to schools, day care facilities and many other venues. This particular product has been embraced by national retailers, including Wal-Mart and Target.

Lauren said...

I don't think you're familiar with the threat t cystic fibrosis patients. Products that do NOT contain alcohol are at risk for being a pathway for B. cepacia strains. Alcohol-free products such as mouthwash, and specifically the Agent Cool Blue mouth rinse have been recalled because of cepacia. For CF patients, especially those who are old enough and responsible enough to use the product, alcohol based santiziers are a good option when soap and water are unavailable.