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HA-MRSA is acquired in the hospital setting and is one of many hospital-acquired infections exhibiting increased antimicrobial resistance

increased during the past decade due to a number of factors including an increased number of immunocompromised and elderly patients; an increase in the number of invasive procedures, e.g., advanced surgical operations and life support treatments; and failures in infection control measures such as hand washing prior to patient contact and removal of non-essential catheters.

CA-MRSA is caused by newly emerging strains unlike those responsible for HA-MRSA and can cause infections in otherwise healthy persons with no links to healthcare systems.

typically occur as skin or soft tissue infections, but can develop into more invasive, life-threatening infections.

occurring with increasing frequency in the United States

tends to occur in conditions where people are in close physical contact, such as athletes involved in football and wrestling, soldiers kept in close quarters, inmates, childcare workers, and residents of long-term care facilities.

During the past four decades, a type of bacteria has evolved from a controllable nuisance into a serious public health concern.

HA-MRSA has increased during the past decade due to a number of factors including an increased number of immunocompromised and elderly patients; an increase in the number of invasive procedures, e.g., advanced surgical operations and life support treatments; and failures in infection control measures such as hand washing prior to patient contact and removal of non-essential catheters.

2005, admissions were triple the number in 2000 and 10-fold higher

In 2005 in th

e United

States alone, 368,600 hospital admissions for MRSA—including 94,000 invasive infections—resulted in 18,650 deaths.

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as community-acquired MRSA (CA-MRSA) infections, according to the Centers for Disease Control and Prevention (CDC).

MRSA has evolved unpredictable resistance and epidemiology patterns in response to decades of successful antibiotic treatments that have been prescribed in all environments and have saved millions of lives.

The most frequent primary diagnosis associated with other S aureus–related infections was cellulitis and abscess, followed by postoperative infection, infections from an implanted device (Fig. 1), or graft and osteomyelitis.

As MRSA spreads into hospitals from the community, current insurance company and proposed governmental policies that penalize the healthcare system may be inappropriate.

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as community-acquired MRSA (CA-MRSA) infections, according to the Centers for Disease Control and Prevention (CDC). Community outbreaks have been reported in sports teams, child care attendees, prison inmates, and diverse populations where habitation is relatively concentrated.

Hospital care — Risk factors for becoming infected with hospital-associated MRSA include the following:●Having a surgical wound and/or intravenous (IV) line●Being hospitalized for a prolonged period of time●Recent use of antibiotics●Having a weakened immune system due to a medical condition or its treatment●Being in close proximity to other patients or healthcare workers who are colonized with MRSA

The skin may have a single raised red lump that is tender, a cluster of "pimples", or a large tender lump that drains pus (called a carbuncle). The area may enlarge and become progressively more tender, red, and swollen. The center of the raised area may ooze pus.

People with infections of the lung, bone, joint, or other internal areas usually require blood tests as well as imaging studies (eg, x-ray, computed tomography [CT] scan, echocardiogram).

Prevention in the hospital — In the hospital, MRSA is commonly spread to patients from the hands of healthcare workers. To minimize this risk, patients and family members can help to ensure that anyone who comes in contact with the patient washes their hands or uses an alcohol-based hand sanitizer before and after touching the patient. Patients with active infection should also wash their hands frequently.

Prevention in the community — The best way to prevent and control MRSA in the community is not clear. The United States Centers for Disease Control and Prevention has made the following recommendations [4]:●Keep hands clean by washing thoroughly with soap and water. Hands should be wet with water and plain soap and be rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly and dried with a single-use towel (eg, paper towels).●Alcohol-based hand sanitizers are a good alternative for disinfecting hands if a sink is not available. Hand sanitizers should be rubbed over the entire surface of hands, fingers, and wrists until dry and may be used several times. Hand sanitizers are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available, visibly soiled hands should be washed with soap and water.●Keep cuts and scrapes clean, dry, and covered with a bandage until healed.●Avoid touching other people's wounds or bandages.●Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms. Other items that should not be shared include brushes, combs, and makeup.●Students who participate in team sports should shower after every athletic activity using soap and clean towels. Athletes with skin infections should receive prompt treatment and should not compete when they have draining or active skin infections.●People who use exercise machines at sports clubs or schools should be sure to wipe down the equipment, including the hand grips, with an alcohol-based solution after using it.

normal for healthy people to have staph on their skin. Many of us do.

sign of a staph skin infection is a red, swollen, and painful area on the skin. Pus or other fluids may drain from this area. It may look like a boil. These symptoms are more likely to occur if the skin has been cut or rubbed, because this gives the MRSA germ a way to "get in."

These staph infections may be in the bloodstream, heart, lungs or other organs, urine, or in the area of a recent surgery. Some symptoms of these severe infections include:Chest painCough or shortness of breathFatigueFever and chillsGeneral ill feelingHeadacheRashWounds that do not heal

cotton swab is used to collect a sample from an open skin rash or skin sore. Or, a sample of blood, urine, sputum (spit), or pus from an abscess may be collected. The sample is sent to a lab to test for staph and MRSA. If MRSA is found, it will be tested to see which antibiotic should be used to treat your infection.

Do not try to pop open or drain the infection yourself. Keep any sore or wound covered with a clean bandage.

Outlook (Prognosis) Expand Section How well a person does depends on how severe the infection is, and the person's overall health. Pneumonia and blood infections due to MRSA are linked with high death rates.

Prevention Expand Section Follow these steps to avoid a staph infection and to prevent an infection from spreading:Keep your hands clean by washing them thoroughly with soap and water. Or, use an alcohol-based hand sanitizer.Keep cuts and scrapes clean and covered with bandages until they heal.Avoid contact with other people's wounds or bandages.Do NOT share personal items such as towels, clothing, or cosmetics.

Cover wounds with a clean bandage. Do NOT touch other people's bandages.Wash your hands well before and after playing sports.Shower right after exercising. Do NOT share soap, razors, or towels.If you share sports equipment, clean it first with antiseptic solution or wipes. Place clothing or a towel between your skin and the equipment.Do NOT use a common whirlpool or sauna if another person with an open sore used it. Always use clothing or a towel as a barrier.Do NOT share splints, bandages, or braces.Check that shared shower facilities are clean. If they are not clean, shower at home.

The aspect of Staphylococcus aureus and its genome that is most concerning revolves around the plasmids that are incorporated/associated with this bacterium’s genome.

Staphylococcus aureus was able to acquire antibiotic resistance through conjugation (horizontal gene transfer) of a plasmid containing a transposon

often code some type of antibiotic resistance.

Beta-lactam antibiotics target penicillin-binding proteins.

prevents proper peptidoglycan and cell wall formation so that cells will eventually burst as the bacteria attempt to grow larger (3).

econd, some bacteria can produce a modified penicillin-binding protein that no longer actually binds the antibiotic which again prevents the desired effects of the antibiotic (3).

The spherical bacteria is gram-positive (contains a peptidoglycan layer in its cell wall) and forms colonies that grow in two planes

High replication rates coupled with the great ability of to perform horizontal gene transfer (especially through conjugation) allow bacteria to develop antibiotic resistance and to spread it quickly

Less than 20 years after the first strains of Staphylococcus aureus were found to be resistant to penicillin, 80% of all strains had acquired penicillin resistance.

The decision to fight MRSA in hospitals revolves around three basic questions. First, is MRSA that much worse than MSSA? Second, how effective can we be in reducing the spread of MRSA? Lastly, is fighting MRSA cost effective?

Type I was isolated in 1961 in the UK, Type II in 1982 in Japan, Type III in 1985 in New Zealand and finally Type V at the start of the 21st century in Australia

In a paper by Deurenberg et al. two theories establishing the relationship between the first MRSA strains and present day MRSA strains are proposed. The first is called the single-clone theory which states that all MRSA clones or present day strains have a common ancestor.

The second theory is called the multi-clone theory. This second theory suggests that SCCmec was introduced several times into different Staphylococcus aureus. According to the paper by Deurenberg et al. the multi-clone theory has received greater support recently and it is from this paper that Figure 3 was taken.

he new antibiotic treatment policies did not prove to be an effective way of fighting the spread of MRSA infections in hospitals. The introduction of alcohol hand gel for improved hand hygiene did however prove to be very effective in reducing the spread of MRSA.

here was a 30% decrease in the spread of MRSA in the hospital. In the intervention hospital the introduction of alcohol hand gel reduced the spread of MRSA by 21%

The decrease experienced in the intervention hospital was likely smaller than that compared to the control hospital because the prevention measures of environmental swabbing for MRSA as well as chlorine disinfection of environments contributed to a 32% decrease in the spread of MRSA and these measures were not taken in the control hospita

It is even likely that these synergistic treatments can be used on other bacterial infections that are resistant to a variety of antibiotics.

After concluding that fighting the spread of and treating MRSA properly is crucial, can we be effective in preventing the spread of MRSA in hospitals?

The continued development of resistance to more and more drugs makes the treatment of Staphylococcus aureus infections and especially MRSA infections is becoming increasingly difficult.

have provided great insight as to what direction the fight against MRSA will be heading in

Staphylococcus aureus is a bacterium that naturally inhabits the skin and nose of humans. If the bacterium is able to enter the body (often through wounds or sores) it can cause a number of infections including those of the bloodstream which can become fatal.

quickly developed resistance to this antibiotic

hand hygiene in hospitals has been an effective way of decreasing the spread of MRSA in hospitals

Methicillin was first used to treat Staphylococcus aureus in 1959

Staphylococcus aureus is a spherical microbe and a member of the bacteria domain. This bacterium can be found naturally on the skin and in the mucus membranes of humans most importantly. In fact, Staphylococcus aureus can be found in the nostrils of up to 30% of people (1). The bacteria is spread most commonly through human contact be it hand-to-hand, from a wound secretion or mucus.

The majority of MRSA infections were wound infections (56.9%) with pneumonia cases being the second most common (21.0%). Potentially the most dangerous infection type, bloodstream infections accounted for 15.1% of the cases and urinary track infection accounted for 6.9%

Despite knowing that hospitals should prevent the spread of MRSA infections due to the risk of even further drug resistance over MSSA strains, and that hospitals can be effective in preventing the spread of MRSA infections, is it cost-effective for hospitals to implement the screening and isolation processes needed to fight the spread of MRSA (even though Staphylococcus aureus infections will undoubtedly occur in hospitals)? In other words, is the cost of hosting patients for longer periods of time, the costs associated with isolating patients

3 to 4 hours after eating the meal, the three adults--who had not eaten another common meal together in the preceding week--had nausea, vomiting, and stomach cramps.

not become ill.

Vomiting ceased after treatment with phenothiazine,

welve cultures of S. aureus recovered from stool samples of the ill family members, food specimens, and nasal swabs of the food preparers were sent to the Centers for Disease Control and Prevention for further testing.

This strain produced staphylococcal enterotoxin C and was identified as being MRSA.

esistant to penicillin and oxacillin

wo different strains of S. aureus recovered from the nasal swab of food preparer B

She reported no recent gastrointestinal illness nor chronic health problems, history of admission to a hospital, or use of antibiotics in the previous 6 months.

visit an elderly relative, who resided in a nursing home, approximately 2 to 3 times each month before the outbreak.

positive for two different strains of MSSA, but not MRSA

Staphylococcal food poisoning is estimated to account for 185,000 foodborne illnesses per year in the United States;

, MRSA has been considered primarily a health- care-associated pathogen, causing invasive disease in which multidrug resistance poses a substantial challenge to successful treatment.

s 20% to 40% of adults are estimated to be colonized at any time, a

MRSA becomes increasingly common in the community

rain has different ways of infecting people and unique ways of protecting itself from antibiotic treatments. An antibiotic that works for one strain may be useless against another

MRSA can cause deadly and aggressively spreading infections

“Mer-suh” this illness is also referred to as Mercer, Mersa, and Merca. MRSA is an acronym for Methicillin Resistant Staphylococcus Aureus. MRSA is caused by a type of Staphylococcus bacteria, which is often shortened to “Staph

MRSA is a type of Staph bacteria (a.k.a. Staphylococcus aureus) that is more resistant to antibiotics

With MRSA being so resistant to many of the best antibiotics, it makes treatment of skin infections and invasive internal infections much more problematic, resulting in many yearly deaths.

o conclusively know if you have a MRSA infection, you’ll need to have a doctor perform a culture test to identify your infection-causing bacteria. If you have a Staph infection, it doesn’t mean you have MRSA

According to the Centers for Disease Control (CDC), in the year 2005, MRSA was responsible for an estimated 94,000 life-threatening infections and close to 19,000 deaths (more than AIDS)

the US in 2003, there were an estimated 12 million doctor or emergency room visits for skin and soft tissue infections suspected to be caused by staph aureus.

MRSA infection in a dairy cow

MRSA infections reported in horses, dogs, cats, pet birds, cattle and pigs.

MRSA is spread by direct physical contact with another person or animal

Athletes Military recruits People with weakened immune systems (i.e., immunocompromised)

Methicillin-Resistant Staphylococcus Aureus

Hospital patients Incarcerated individuals Nursing home residents

Children in day care

(reverse zoonotic

Methicillin-Resistant Staphylococcus Aureus or MRSA (usually pronounced "mur-sah") is a type of bacteria. Staphylococcus aureus is a common bacterium on skin, and it is not usually a problem. However, when the Staphylococcus aureus bacteria are not susceptible to the antibiotic methicillin (ie, methicillin does not kill the bacteria or stop its growth), it is considered to be MRSA. Bacteria resistant to methicillin are often resistant to other antibiotics as well.

If MRSA is present, it is commonly carried on the skin or in the nasal passages of healthy people and/or pets. If an infection is present, it can be found almost anywhere—especially where there's a skin wound or sore

does not exhibit symptoms of disease is considered to be "colonized

who do exhibit symptoms

considered "infected"

Scanning electron micrograph (SEM) depicting MRSA bacteria with a human white cell.

Handrub using ethanol (Sterillium®); waterless, alcohol-based, antiseptic handrub solution used for 30 seconds.

ompared the effectiveness of three modes of different hand hygiene practice among health care workers:

Handwash using chlorhexidine gluconate (Hibiscrub®); water-based, antiseptic handwashing soap used for 1 minut

Waterless, alcohol-based antiseptic gel handrub for 30 seconds.

The study showed that repeated handrubbing for 30 seconds with Sterillium was better tolerated than repeated handwashing with the antiseptic soap Hibiscrub during patient care.

There was greater compliance with the hand hygiene practice using the 30 second Sterillium handrubbing technique compared to the 1 minute handwashing technique with Hibiscrub.

failures in infection control measures such as hand washing prior to patient contact and removal of non-essential catheters.