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Nursing Homes Remain Ideal Breeding Grounds For Strains Of MRSA Infections

MRSAMRSA (Methicillin-resistant Staphylococcus aureus) is an infection that is caused by a strain of staph bacteria that is resistant to the antibiotics typically used to combat staph infections.  HA-MRSA or health care-associated MRSA affects people who are or have been in hospitals, nursing homes, dialysis centers, or other health care settings, especially those who have undergone surgery or invasive procedures.

CA-MRSA or community-associated MRSA occurs in communities of healthy people, such as child care workers, high school wrestlers, or people living in crowded conditions.
Community-associated MRSA usually starts as a painful skin boil or abscess that is often confused with spider bites, and it can be spread through skin-to skin contact.  See photos of MRSA skin infections.  Risk factors include:

  • Participating in contact sports – increased skin-to-skin contact and abrasions/wounds
  • Living in crowded or unsanitary conditions – military training camps, child care centers, dormitories, athletic facilities, and jails/correctional facilities
  • Men having sex with men – homosexual men have an increased risk of MRSA infections

CA-MRSA incidence varies geographically (see 5) and disproportionately affects children, young adults, and individuals in racial minority groups or low socioeconomic status.  In some settings, limited access to health care and frequent antibiotic exposure can lead to the spread of infection.

The CDC released a report “Strategies for Clinical Management of MRSA in the Community: Summary of an Experts’ Meeting Convened by the Centers for Disease Control and Prevention. Then, the American Medical Association and the Centers for Disease Control (CDC) collaborated to create an informational flow chart for doctors in order to treat and manage CA-MRSA.

The chart is an easily understood breakdown of the clinical strategies recommended by the CDC.  First, it asks whether the patient presents signs/symptoms of skin infection:

  • redness,
  • swelling,
  • warmth,
  • pain/tenderness,
  • complaint of “spider bite.”

If the answer is YES, then the next question is whether the lesion is purulent – whether any of the following signs are present:

  • fluctuance (palpable fluid-filled cavity, moveable, compressible),
  • yellow or white center,
  • central point or “head,”
  • draining pus,
  • possible to aspirate pus with needle and syringe.

If the answer is NO, the handout suggests:

  • provide antimicrobial therapy with coverage for Streptococcus spp. and/or other suspected pathogens
  • maintain close follow-up
  • consider adding coverage for MRSA if patient does not respond.

If the answer is YES, the handout suggests:

  • draining the lesion,
  • sending wound drainage for culture and susceptibility testing,
  • advising patient on wound care and hygiene, and
  • discussing a follow up plan with the patient.

Then, if there are systemic symptoms, severe local symptoms, immunosuppression, or failure to respond to incision and drainage (I&D), the doctor should consider antimicrobial therapy with coverage for MRSA in addition to I&D.  The antimicrobial therapy includes information on Clindamycin, Tetracyclines (Doxycycline and Minocycline), Trimethoprim-Sulfamethoxazole, Rifampin, and Linezolid, as well as a discussion of considerations and precautions for each.

The CDC also recommends steps for personal prevention of MRSA infections through good hygiene:

  • Wash hands thoroughly
  • Keep cuts and scrapes clean and covered with a bandage until healed
  • Avoid contact with other people’s wounds/bandages
  • Avoid sharing personal items such as razors and towels

The CDC also has recommendations if you have MRSA:

  • Keep your wound covered and follow your doctor’s instructions for proper care
  • Clean your hands frequently with soap and water and suggest the same for people in close contact with you
  • Do not share personal items
  • Keep your environment clean
  • Talk to your doctor about what you can do to prevent spreading your infection to others

MRSA, which people tend to associate with hospital or health care acquired skin infections (HA-MRSA), is also a serious problem among healthy communities.  Community-associated MRSA is an invasive infection that can attack otherwise healthy individuals.  Increased education and awareness coupled with better hygiene and sanitary conditions can help combat CA-MRSA and protect at risk populations.

Sources:
CDC: Strategies for Clinical Management of MRSA in the Community – Summary of an Experts’ Meeting Convened by the Centers for Disease Control and Prevention

CDC: MRSA Infections
Mayo Clinic: MRSA Infection

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