2009 MRSA Update

Since my original article on MRSA (methicillin-resistant Staphylococcus aureus) was published in 2006, it's had over a quarter of a million page views. I feel it is time to write an updated article on this important topic.

MRSA, which was discovered in 1961, has emerged as an increasingly fatal infection-a superbug that is resistant to most forms of penicillin and cephalosporins. MRSA commonly colonizes in the nostrils and can cause life-threatening pneumonias, necrotized skin and wound infections, and is a particular problem in children, the elderly, and people with weak immune systems.

The bacteria "staph" (Staphylococcus aureus) is commonly found on the skin and in the nose of healthy people. Due to over-usage of antibiotics, the staph bacterium has become resistant to the commonly used broad-spectrum antibiotics that had previously been used to treat staph infections. Since 2005 more than 94,000 MRSA cases have been reported in the United States, and an estimated 19,000 MRSA deaths have occurred.

Research reports a new concern that MRSA appears to be spreading among agricultural animals; mainly swine in the Midwest. According to Tara Smith, Ph.D., Associate Professor of Epidemiology at the University Of Iowa College Of Public Health: "Our results show that colonization of swine by MRSA was very common in one of two corporate swine production systems we studied. Because ST398 (MRSA) was found in both animals and humans, it suggests transmission between the two. Our Findings also suggest that once MRSA is introduced, it may spread broadly among both swine and their caretakers. Agricultural animals could become an important reservoir for this bacterium."

Source: (http://www.sciencedaily.com/releases/2009/01/090122202804.htm)

MRSA has also been found in other more domestic animals including dogs, cats, cattle and horses. The infection has become a significant issue in Veterinary medicine and some veterinarians believe all animals in the household should be screened for MRSA.

Even though the staph bacterium has become resistant to the commonly used broad-spectrum antibiotics, some newer antibiotics are effective in treating MRSA. Bactrim and Vancocin (vancomycin) are often the first drugs of choice. Other options are Cleocin, minocycline, Cubicin, Zyvox, and Synercid. Some of these are only available intravenously. It appears there is also emerging antibiotic resistance being seen with some of these medications.

The following are a few suggestions on what you can do to help reduce your risk of getting MRSA:

Wash your hands. Careful hand washing is your very best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 62% alcohol for times when you can't wash with soap and water.

Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.

Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores may contain MRSA and keeping wounds covered will help prevent the bacteria from spreading.

Shower after athletic games or practices. Shower immediately after each game or practice. Use soap and water. Don't share towels.

Sit out athletic games or practices if you have a skin infection. If you have a wound that's draining or appears infected - red, swollen, warm to the touch or tender - sit out athletic games or practices until the wound has healed.

Sanitize linens. If you have a cut or sore, wash towels and bed linens in a washing machine with HOT water (add bleach, if possible) and dry them in a HOT dryer. Wash gym and athletic clothes after each wearing.

Get tested for MRSA if you have a skin infection that requires treatment. Doctors may prescribe drugs that aren't effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs. Testing specifically for MRSA helps get you the specific antibiotic you need to effectively treat your infection.

Use antibiotics appropriately. When you're prescribed an antibiotic, take all of the doses, even if the infection is getting better. Don't stop until your doctor tells you to stop. Don't share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics, including not taking all of your prescription and overuse, contributes to resistance. If your infection isn't improving after a few days of taking an antibiotic, contact your doctor.

Precautions to follow if someone in your home has MRSA:

Wash your hands with soap and warm water often and after any contact with sores, infected band-aids, bandages, or dressings.

Keep any skin infections, especially those with pus or drainage, covered with a clean, dry bandage.

Avoid sharing personal items (towels, razors, etc.) that may come in contact with infected fluids.

All clothing, towels and linens that come in contact with the wound should be washed separately from those of other members of the household. This includes using a separate hamper. Wash linens, towels and clothes in hot water and laundry detergent (and bleach if appropriate) and dry in a hot dryer.

Clean the infected person's room, personal items, and non-cloth items that come in contact with the wound or drainage with a commercial disinfectant or a fresh solution of one part bleach to 100 parts water (one tablespoon of bleach to one quart of water). Be sure to make a fresh solution every day. A phenol-containing product such as Lysol or Pinesol may also be used and a phenol-containing spray can be used to disinfect cloth and upholstered surfaces if needed.

The infected person should have a designated chair or area for sitting as long as there are still draining wounds. This chair or area should have a hard surface or an easily cleaned plastic or similar covering that can be disinfected. No one else should sit in the area until the wounds have healed. The chair should be disinfected after the infected person sits on it. (See disinfecting solutions above).

Wear gloves if you handle bodily fluids (blood, urine, wound drainage) or have to change dressings. Wash your hands well with warm water and soap after removing the gloves.

Carefully dispose of dressings and gloves in a plastic bag. Again, wash your hands well after discarding the plastic bag. The plastic bag may be disposed of with the regular household trash. Make sure it is closed securely.

If you have an infection or develop an infection, inform your health care provider about the MRSA in your household.

PEOPLE WITH MRSA INFECTIONS SHOULD LIMIT CLOSE CONTACT WITH PEOPLE HAVING OPEN SKIN LESIONS.

The most important treatment of MRSA is prevention of the infection in the first place.