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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.

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.

Prepare ahead of time for your hospital stay.

Your goal as a hospital patient will be to avoid being a hospital infection statistic.

Plan for times you can't advocate for yourself.

How to Prevent Hospital-Acquired Infections

he only patients hospitalized are those who are very sick,

Hospitals are dangerous places to be for several reasons.

need surgery that can't be performed in an outpatient facility,

who have severe injuries. In all cases, these patients are at grave risk for acquiring infections, called "nosocomial" infections

According to the CDC, about 1.7 million Americans are infected in hospitals every year

According to the CDC, about 1.7 million Americans are infected in hospitals every year.

Most are immunocompromised. Almost 100,000 of them die.

Almost 100,000 of them die

Your goal as a hospital patient will be to avoid being a hospital infection statistic.

While it is impossible to prevent every nosocomial infection, here are some steps you can take to attempt to keep yourself, or your loved one, from acquiring an infection while in the hospital:

While it is impossible to prevent every nosocomial infection,

Know how hospital infections spread.

nsist on hand washing.

Choose the cleanest hospital for your care or treatment.

Choose a doctor with a lower infection rate.

Prepare ahead of time for your hospital stay.

Insist on hand washing.

Prevent the spread of germs from unsafe surfaces.

Insist catheters be removed or replaced as soon as possible.

Plan for times you can't advocate for yourself.

that has continued to grow now. It approaches 60% across the United States in many of the intensive care units (ICUs)

MRSA has progressed at an average rate of about 2% over the past couple of years.

prevalence of MRSA is highly globa

areas where prevalence is fairly low -- in the Netherlands less than 1% and in Canada 2.3%

2 policies that both countries have

One is a strict search-and-destroy policy: patients from other countries and those with MRSA are isolated upon hospital admission until screening cultures for MRSA are proven negative. The second is a restrictive prescribing policy in which the defined daily dosage used per 1000 people per day in primary healthcare is around 8.9.

aureus was found to be the predominant pathogen in nosocomial skin and skin-structure infections

year 2000.

vancomycin, which is static, as well as some of the beta-lactamases

delay in appropriate treatment

resistant organisms lead to delays in appropriate treatment, and that delays in appropriate treatment lead to resistant organisms

Increased cost of MRSA

MRSA in the bloodstream costs about 3 times more and results in 3 times longer the length of stay

vancomycin has the FDA indications, with linezolid second. Daptomycin and tigecycline are approved for skin and skin-structure infections, but quinupristin-dalfopristin is not approved for complicated skin and skin-structure infections with MRSA.

ventilator-associated pneumonia due to MRSA

surgical patients with resistant gram-positive cocci showed a higher mortality rate and increased length of stay

we had hardly any incidence of MRSA in the 1960s, 1970s, and 1980s in the United States

higher association with MRSA than with MSSA

fluoroquinolones, macrolides, previous hospitalizations, enteral feeds, surgery, and the length of stay before culture are independently associated with MRSA infections.

CA-MRSA infections

infections in the community usually manifest as skin infections, such as pimples and boils

occur in otherwise healthy people

HA-MRSA patients are in long-term care facilities, have comorbidities (such as diabetes), are on dialysis, have prolonged hospitalization, and are ICU patients

HA-MRSA is more multidrug resistant

In HA-MRSA, one sees nosocomial pneumonia, catheter-related urinary tract infections, bloodstream infections, and skin and skin-structure infections.

initially resulted from a recombination event, one involving the gene encoding in existing PBP and an inducible beta-lactamase gene.

In terms of microbiologic cure rates at the test-of-cure visit, linezolid was also superior to vancomycin.

Pharmacoeconomic analysis of this comparative trial in complicated skin and skin-structure infections showed that compared with vancomycin, linezolid reduced the length of stay and duration of IV treatment by about 2 days.

other studies have not found this similar association.

Vancomycin is IV only. It is more costly -- even as a generic, based on pharmacoeconomic data -- relative to linezolid.

Quinupristin-dalfopristin is IV only and may cause phlebitis, requiring central line placement.

Linezolid is relatively new; is more expensive (on an acquisition basis) compared with vancomycin; has reversible hematologic and, with long courses, neurologic effects; and has developed some resistance, mainly in enterococcal infections, with prolonged use and with failure to remove retained foreign bodies.

Daptomycin is IV only; quite new; has limited indications; is also expensive, compared with vancomycin; has a muscle effect requiring monitoring of creatine phosphokinase; is inactivated by surfactants, thus obviating its use in pulmonary infections; and to date has no pharmacoeconomic data.

Tigecycline is IV only, very new, and has a broader spectrum than any of the other agents in that it has some gram-negative activity

Dalbavancin is IV only, and we need to have the official data on safety, tolerance, efficacy, indication, and pharmacoeconomics, which will probably be available later this year.

many strains of MRSA

often associated with hospitals and other medical institutions

When the bacteria attacks the organs – and it can be found in any organ in the body – it can cause a number of potentially fatal problems, including: endocarditis

Prognosis

Estimates have put the mortality rate in MRSA patients at somewhere between four and 10%; the numbers of patients suffering from the infection ranks at millions at any one time across the world.

kidney and lung infections, necrotizing faciitis, sepsis, and many more diseases of the organs. This is why it is vital that early

diagnosis is made.

“MRSA has become so widespread in the community, that it’s become nearly impossible to predict which patients harbor MRSA on their body,”

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

prevent the spread of staph is for everyone to keep their hands clean

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.