Methicillin-Resistant Staphylococcus Aureus
Staphylococcus is one of the bacteria that commonly plague the human species. The bacteria have been in existence for centuries, and have been linked to certain diseases including the incurable boils that affected the Egyptians in the Bible. These bacteria were named from the Greek word ‘staphylos’ which means ‘berry’ or ‘seed’. Various strains of the bacteria have also been observed to affect the human body differently and with different treatment outcomes. One of the varieties of staphylococcus is the staphylococcus aureus, which has continued to surprise scientists due to its capability to mutate and to develop resistance to most of conventional antibiotics. S. aureus, therefore, is considered a versatile pathogen, which evolves as part of its adaptation to the antibiotic era. For instance, the bacteria developed resistance to penicillin by 1942, only one year after the discovery of penicillin as a miraculous antibiotic (Stryjewski & Corey, 2014). The bacteria’s resistance to penicillin and other antibiotics is based on the presence of an inducible beta-lactamase. The species developed resistance against other antibiotics including erythromycin, tetracyclines and streptomycin.
Due to the resistance to the different strains of antibiotics, methicillin was introduced in 1959. However, another strain of S. aureus emerged and was named the methicillin-resistant S. aureus (MRSA), and was discovered only two years after methicillin introduction (Stryjewski & Corey, 2014). This strain has been in existence since then and continues to be a plague in the modern day society. The present paper discusses this disease in the context of healthcare service provision. The objective of the paper is to develop an understanding of the disease, its causes, progression and treatment. MRSA has continued to be a significant pathogen in both hospital and home based settings, and its resistance to other drugs besides methicillin has become a challenge to be controlled. In particular, recent clinical research and evidence-based practice has shown that MRSA is becoming more resistance to glycopeptides, vancomycin and newer therapies, raising concerns about its heteroresistance, and emergence of intermediate resistant and fully resistant strains.
The spread of MRSA is by contact. This means that one can get the disease through touching an infected person. Like most of the other staphylococcus species, MRSA is spread when there is contact between an infected person’s skin and a wound on another person’s skin. Another way through which it can be caused is by touching objects that contain bacteria. Nearly 2% of the population carry MRSA although most of them do not have the infection and cannot pass it to others (Nichols, 2017). The infections are more common among people with a weak immune system or those in hospitals, nursing homes as well as other healthcare facilities. For people in such facilities, infections may appear around surgical wounds and/ or invasive devices such as implanted feeding tubes, IVF lines and catheters. With technologies and practices that aim at reducing infection rates in healthcare facilities, MRSA infections declined in hospitals by 8% between 2011 and 2013.
While MRSA was commonly associated with healthcare facilities, community acquired strains have become more common in recent years. According to Stryjewski and Corey (2014), community acquired MRSA infections were rarely reported in the earlier decades. The community acquired form became more common in the 1990s and was a major cause of concern. There are multiple and unique strains of MRSA that can be community acquired, and this has led to several challenges in controlling and/ or managing the condition among patients. The strains affect young people within the community and without any contact with healthcare facilities, and result in purulent skin infections. They may also cause pneumonia among the infected patients. Additionally, the community acquired strains differed from the hospital or healthcare facility acquired strains since they were susceptible to several non-beta-lactam antibiotics. They also commonly carried the SCCmec type IV and the genes for Panton-Valentine leukocidin (PVL) (Stryjewski & Corey, 2014).
Felson (2017) also mentions the prevalence of community acquired MRSA among young people. For instance, the average age of those affected by MRSA within a hospital setting is 68 while that of those affected with the CA-MRSA is 23 (Felson, 2017). The CA strain is more common among certain populations, particularly those who share close quarters and have more propensity for skin-to-skin contact. For instance, such populations may include athletes in a team, prison inmates, military recruits and children in a daycare. Among the general public, more instances of CA-MRSA are also increasingly being seen within specific geographical regions. Nichols (2017) also points out other risk factors for the CA-MRSA infections. Some of these factors include homosexual sexual activity, particularly between men and intravenous drug use. Intravenous drug use is reported to increase the risk of MRSA by up to 16.3%. Since either form of MRSA is resistant to antibiotics, they can spread to life threatening conditions.
It is becoming increasingly important to rapidly diagnose MRSA infections. This is to ensure positive outcomes are achieved in therapeutic management of the disease. Given that the traditional bacterial culture and susceptibility testing, which was used more commonly for MRSA testing take long to detect the pathogen, rapid diagnostic tests for the pathogen are increasing in use. Differential and selective procedures for testing MRSA infection have become more common and more effective in diagnosis. The progression of MRSA also requires such rapid testing procedures to avoid negative outcomes. Griffin and Hamilton (2010) point out that MRSA has been recognized as a worldwide pathogen especially in immuno-compromised individuals within hospital settings. At the onset of the infection, the symptoms range from skin infections (boils), impetigo and other outcomes such as furuncles and carbuncles. These progress further as the disease escalates, and result in complicated infections such as staphylococcal scalded skin syndrome (SSSS), bacteremia, endocarditis, toxic shock syndrome (TSS) and staphylococcal pneumonia (Stryjewski & Corey, 2014).
Disease Management and Treatment
The treatment of MRSA has been a major cause of concern for healthcare professionals. This is particularly due to the prevalence of nosocomial infections (MRSA), which are difficult to control through the existing infection control measures including patient isolation, MRSA screening and precautions against contact. The CA-MRSA strain is even more difficult to manage outside the healthcare settings, and any efforts to caution against contact can only come after observed infection (Stryjewski & Corey, 2014). Prevention and control becomes all the more difficult in a community based setting where the spread of MRSA is unpredictable. Because of these concerns, various recommendations have been made on the prevention of MRSA, particularly within the community. For instance, maintaining a strong hygiene culture is one of the recommended practices for the community. Proper hand-washing using the right procedures; using hand sanitizers for when one does not have access to hand washing facilities; keeping all wounds and abrasions covered with a dry bandage at all times to avoid contact with infected people or things; avoiding sharing personal items such as towels, toothbrushes and clothing to avoid MRSA spread through contact with objects; showering well after intense activities such as games; sanitizing all linens after use; and avoiding intravenous drug usage are some of the recommended practices that can help in preventing MRSA infections (Felson, 2017).
Prevention of hospital acquired MRSA begins with the implementation of thorough cleaning procedures. Hospital surfaces, healthcare providers’ clothing and visitor clothing all have to be kept clean at all times. For healthcare providers, protective clothing should be used when visiting or attending to patients infected with MRSA. This helps to protect both the providers and the other patients from infection transmission. Patients with MRSA are also to be informed to limit their stay in hospital common areas, and if possible be isolated from general patient populations (Nichols, 2017). Such patients may be kept in single rooms or in rooms shared with other MRSA patients. Moreover, visitors and healthcare providers need to remove their protective clothing as soon as they come out of the room where MRSA patients stay. This would help confine the bacteria to the secluded area and thus prevent further infections. For the already infected people, further treatment practices are recommended.
While the common perception is that MRSA is antibiotic resistant, both HA- MRSA and CA-MRSA can respond to certain antibiotics. As such, antibiotics can be used for the treatment of MRSA where necessary, although this is not always required. For instance, in cases where a superficial abscess is caused by MRSA, a physician may prescribe draining the abscess rather than treating the MRSA pharmacologically (Griffin & Hamilton, 2010). The specific type of treatment after diagnosis depends on a variety of factors including the infection type, the location of infection and the degree of severity of the symptoms and the antibiotics to which the specific strain of MRSA responds. This implies that there are multiple approaches to management and multiple medications of MRSA, whose choice will be influenced by the mentioned factors. For instance, Nichols (2017) points out that some approaches to MRSA management may include culture and susceptibility testing for the pus drained from the MRSA lesion, wound care and hygiene practices as well as antimicrobial therapy where cellulitis occurs without an abscess.
In cases where medications have to be used for the treatment of MRSA, some of the medications that can be chosen from include trimethoprim and sulfamethoxazole, doxycycline and minocycline as well as other tetracycline drugs, rifampin, clindamycin and linezolid (Nichols, 2017).
MRSA is a significant pathogen in any healthcare setting and efforts to reduce its prevalence are increasingly important. The pathogen, which has shown resistance to methicillin and other antibiotics, affects those who are immuno-compromised such as the old and the sick, particularly in hospital settings. At the same time, the community acquired strain of the pathogen can affect people in the communities. The infection usually occurs as a result of contact with the skin of individuals with MRSA especially where there are open wounds and/ or contact with objects on which the pathogen exist. Due to the resistant nature of the pathogen and its progressive tendency, the treatment of MRSA is a challenge to healthcare providers and to the general patient populations. Various measures have been provided to aid in the prevention of the condition and to guide its treatment.
Felson, S. (2017, March 21). Understanding MRSA infection – the basics. WebMD. Retrieved from www.webmd.com/skin-problems-and-treatments/understanding-mrsa#2
Griffin, B.R., & Hamilton, L.A. (2010). Progression of a recurrent community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection. Laboratory Medicine, 41(6), 329-333. Retrieved from academic.oup.com/labmed/article/41/6/329/2657536
Nichols, H. (2017, November 13). All you need to know about MRSA. Medical News Today. Retrieved from www.medicalnewstoday.com/articles/10634.php
Stryjewski, M.E. & Corey, G.R. (2010). Methicillin-resistant Staphylococcus aureus: An evolving pathogen. Clinical Infectious Diseases, 58(1), S10-S19. Retrieved from academic.oup.com/cid/article/58/suppl_1/S10/507083