Multi Drug Resistant: “Super Bug” MRSA Infection
MRSA stands for Methicillin resistant Staphylococcus cures known as the “super bug”. It’s an infection which is becoming increasingly difficult to control due to drug resistance.
What is Staphylococcus Aures ?
Staphylococcus Aures or Staph aures is a bacteria. In about 30% of the population it colonizes on the skin and nostril, but does not cause an infection. These people are known as carriers. In other words they harbor the bacteria but do not succumb to the infection.
Infections caused by Staph were usually treated with antibiotics containing a beta lactam ring in their chemical structure, such as penicillin. As drug resistance emerged, Staph proved resistant to Penicillin, Erythromycin and Tetracycline. In 1951 a high order penicillin known as methicillin was introduced.
Emergence of MRSA
In 1961 in UK the first case of resistance to methicillin was discovered, and named as methicillin resistant Staph. Aures or MRSA. Thereafter it spread rapidly to Australia, Japan and U.S.A. A study done by the Centre for Disease Control and Prevention published in the Journal of American Medical Association in October 2007 states that MRSA is responsible for 94.360 serious infections and 18,650 hospital stay related deaths in USA in 2005.
Since methicillin became resistant, Staph infections are treated with vancomycine. But the inevitable is already happening with resistance developing for vancomycine as well. Vancomycine intermediate Staph aures has already been identified.
Types of MRSA
Two types of MRSA have been identified. Namely, Hospital acquired and community acquired.
In the past only the Hospital acquired MRSA was known, but now a more virulent MRSA that is spreading rapidly to cause Community acquired MRSA has been identified. The latter has a gene which encodes a toxin known as Panton valentine Leukocidine, which is responsible for rapid destruction of tissues.
Spread of MRSA
Spread occurs in the following ways-
By hand
By direct contact with and infected person or a carrier
By contact with surfaces or equipment that are colonized by the
Organism
By droplets through the respiratory pathway
The bacteria relocate by the above methods to a susceptible individual to cause an infection.
Who is Susceptible to the Infection?
In Hospital acquired MRSA infections, patients who are critically ill, with multi organ failure, are immunocompromised and are on multi drug treatment are prone to get MRSA infections.
Community acquired MRSA spreads in crowded situations with poor hygienic conditions. It’s also found in prisons , old age homes etc.
Signs and Symptoms of MRSA
In the community it commonly causes boils, rashes and abscesses. If not detected and treated early it can go onto more serious flesh eating pneumonias like necrotizing pneumonia and rapidly destroying tissues infections like necrotizing fascitis, and also cause toxic shock syndrome. Fever and rash is the earliest sign to manifest.
In Hospital acquired it can affect any organ blood, lungs, urine, wounds and sites of any invasive lines like intravenous cannulae.
How is it Diagnosed ?
Diagnosis is by taking sample swabs from infected sites and culturing the organism in the laboratory. This takes a few days. Nowadays in some countries a test known as PCR studies where genetic material from the organism can be identified is being used for more rapid detection of MRSA.
Treatment
Currently treated with vancomycine and teicoplanin. Both belong to the glycopeptide group of antibiotics. Now since vancomycine intermediate Staph. Aures is emerging a new drug known as linezolid is coming into the picture.
Prevention of MRSA
In the community simple techniques of hand washing with soap and water and good hygienic conditions and sanitation with proper nutrition to combat infections will keep MRSA at bay.
In hospitals several methods are used. Starting from simple hand washing before examining a patient, and barrier nursing( one nurse to attend on a MRSA patient) to screening for MRSA colonization on skin before sepsis takes place and decolonizing the patient.
For hand washing, soap and water is very good. But also used are alcohol and more effectively chlohexedene washes.
Cleaning of surfaces with alcohol, quaternary ammonium and alcohol and non flammable alcohol vapor in carbon dioxide for metals and plastics is used.
Decolonization is done with chlohexedene wash from head to toe and 2% mupirocin cream applied to the nostrils.
MRSA is causing severe infections, whatever the site of origin of the infection. It can spread rapidly in to the blood stream and spread inside the body involving all tissues and organs. Because it is resistant to almost all the antibiotics, this infection has a high mortality rate, and our best chance at getting at this “super bug” is prevention.
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