MRSA Community Acquired Methicillin Resistant Staphylococcus Aureus Community Health Nurse Specialist

What is Staphylococcus aureus? A type of bacteria. Known as “staph” Very common cause of skin infections. Found on the skin and in the noses of healthy people. Staphylococcus aureus, often referred to simply as "Staph," are bacteria commonly carried on the skin or in the nose of healthy people. The human body is a natural reservoir for Staphylococcus aureus. Nasal cultures reveal that approximately ten to thirty percent of all humans are symptom free carriers of Staphylococcus aureus. Many healthy people carry the bacteria on their skin. MRSA is a staph that is simply resistant to commonly used antibiotics.

Potential Sites or Sources of Staph infections 􀂄􀂄 Asymptomatic colonization 􀂄􀂄 Skin and soft tissue infections 􀂄􀂄 Deep tissue abscesses 􀂄􀂄 Bone and joint infections 􀂄􀂄 Catheter and device-related infections 􀂄􀂄 Sepsis and endocarditis 􀂄􀂄 Necrotizing pneumonia 􀂄􀂄 Staphylococcal toxic shock syndrome Enterotoxin produced by staph is frequent cause of Food poisoning. SSSS primarily strikes children under the age of five, particularly infants. It can also strike other age groups who have weakened immune systems. Such immunocompromised patients include those with kidney disease, people undergoing cancer chemotherapy, organ transplant patients, and individuals with acquired immunodeficiency syndrome (AIDS).

Cultured Staphylococcus aureus Note that staphylococcus aureus colonies are golden yellow. The strong yellow pigment makes the bacteria resistant to Hydrogen Peroxide, the pigment serves as an antioxidant. It also makes the bacteria resistant to neutrophils and other whole blood agents that kill bacteria. This pigment also contributes to the virulence of the bacteria.

What are the differences… Hospital Acquired -vs- Community Acquired? Sick Elderly Recent hospital stay Surgery Dialysis Patients undergoing an invasive medical procedure. Health People Young Athletes Children attending daycare/school Intravenous drug users Over the past twenty years, reports of Community-acquired-MRSA (CA-MRSA) began to surface in gradually increasing numbers. Initially those found to be at risk for CA-MRSA were IV drug users, adults with frequent contact to the healthcare system, and men having sex with men. In the early 1990s, reports of CA-MRSA infections occurring in healthy children with no known risk factors for the MRSA infection began. Approximately 95% of CA-MRSA infections are skin and soft tissue infections (Chambers, 2001). Skin and soft tissue infections can spread to muscle, bones, and organs or enter the blood stream. Children and adolescents are at increased risk for CA-MRSA because of their environments such as daycare, schools and their behaviors that differ from most adults such as participation in competitive sports (especially contact sports such as wrestling, football, and basketball), and close contact of persons with CA-MRSA (David, Crawford, Boyle-Vavra, Hostetler, et al., 2006).

Characteristics of CA-MRSA Spreads quickly Often looks like a “spider bite” Can release very strong toxins that destroy tissue Bacteria is mutating and becoming a more prominent infection worldwide CA-MRSA reproduces 2-3 times faster than HA-MRSA.

CA-MRSA Misdiagnosed Commonly misdiagnosed as: Simple staph infection Spider bite Delayed proper treatment leads to: Increased chance of spreading infection to others Increased severity of infection Increased risk of fatality Even though many students see a physician for skin infections, they are often misdiagnosed. Physicians have to be made aware of regional outbreaks of CA-MRSA. They need to learn to consider the possibility of CA-MRSA in otherwise healthy patients with a history of risk factors. Study 2: At an outpatient health care facility for indigent patients in San Antonio, Texas, Tamara J. Dominguez, MD conducted a case review of 10 patients diagnosed with CA-MRSA skin infections to develop screening questions to aid in the early diagnosis and treatment of CA-MRSA. Factors leading to the classification of infections diagnosed as CA-MRSA were no known risk factors for HA-MRSA, not a current IV drug user, not diagnosed with underlying medical conditions that could predispose patients to MRSA, and antimicrobial resistance patterns were consistent with CA-MRSA. The ten cases selected had Staphylococcus aureus positive aerobic/anaerobic wound cultures. To assess common factors among the ten cases, Dominguez reviewed the individual medical charts. Those factors included; six patients with recent contact to a recently released prison inmate, a prison guard, or other prison faculty, four recently released prison inmates (one was a nasal carrier of CA-MRSA), one case played on his HS football team, several patients reported treatment by other providers for presumed spider bites. Treatment with clindamycin, mupirocin, and incision and drainage of any abscesses present was effective in all ten cases. All of the isolates were resistant to Amoxicillin, Oxacillin, and Penicillin. They were all sensitive to Clindamycin, and Vancomycin. Questions that a clinician might ask a patient with a possible Staphylococcus CA-MRSA skin infection should include: Has the patient had contact with a correctional facility, prisoner, or former prisoner? Have they or any of their close contacts been recently treated or told they had an infection from a spider bite? Have they been treated for recurring skin infections such as impetigo or furunculosis? Do they play any type of contact sport or work or work out at a gym or other sports facility? The early recognition and treatment of CA-MRSA is critical. Responses to these questions could help to determine potential risk and have bearing on treatment prescribed (Dominguez, 2004).

How Is MRSA Spread? Direct physical contact with someone who has an open, infected sore Direct physical contact with a contaminated personal item or a contaminated surface Sharing needles, drug “works” or tattoo equipment are particularly high-risk activities MRSA bacteria from the infected sore can spread to the person’s hands or other parts of the skin. Contaminated personal item (such as a towel, washcloth, clothing, sheets, soap, bandages or razor) Shared equipment (such as shared sports equipment).

Signs and Symptoms of a Staph Infection Small red bumps resembling pimples, boils or spider bites. The site may be warm, red and painful to touch. Can turn into deep, painful abscesses. Can cause potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs. Generally start as small red bumps that resemble pimples, boils or spider bites. Can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. They can burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.

Minor “Staph” Infection Typical infection is in the form of a boil or folliculitis. Ulcerated wound Arms and legs are common sites of infection.

Staphylococcus aureus Skin and Soft Tissue Infections It is not the nurses place to diagnose the type of infection. If a student has what appears to be an infected wound you have to consider the possibility that the infection is caused by staph. Because there are some potentially life threatening strains of staph infections, the student must be referred to a physician. The first picture looks pretty bad. The infection has spread in all directions and swelling seems to be impairing circulation. Exclusion and drsg requirements will be the same The second picture is of an ulcerated , infected wound. Refer to a physician. Exclude until 24 hours after tx is initiated. Keeping wound covered with a clean dry dressing is advised. .

Staphylococcus aureus Skin and Soft Tissue Infections Note this picture shows what appears to be a large pimple or insect bite. It is the fact that the infection is spreading as evidenced by the reddened streak that suggests that this is an infection in need of immediate medical attention and that this student should be excluded until 24 hours after tx is initiated. Keeping wound covered with a clean dry dressing is advised.

Staphylococcus aureus Skin and Soft Tissue Infections This picture shows infection from tattooing. There are multiple infection sites and pustules present. Exclude from school until 24 hours after tx is initiated. Keeping wound covered with a clean dry dressing is advised.

STOP THE SPREAD OF MRSA!

Stop the Spread of MRSA … Wash your hands! Wash often with soap and warm water for 20 sec! Wash your hands! Keep cuts and abrasions covered DO NOT share towels, personal items, clothing or equipment.

Stop the Spread of MRSA … X Shower with hot water and wash with soap. Use pump soap, not bar soap. Clean and disinfect items such as gym and sports equipment.

Avoiding Resistance to ABT (antibiotic therapy) Do not overuse antibiotics! Antibiotics will not help a virus Take ALL of your antibiotics when on ABT! Don’t save them for a later date or for someone else!

Questions?