Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria responsible for difficult-to-treat and potentially fatal infections in humans. MRSA is any strain of Staphylococcus aureus that has developed resistance to specific antibiotics.

MRSA is problematic in hospitals, prisons and nursing homes. Patients with open wounds, invasive devices, or weakened immune systems are at the greatest risk of institutional infections. MRSA can also be community-acquired. It spreads easily. because it can survive on surfaces and fabrics including uniforms worn by health care workers and staff for long periods.

People who are at risk for developing MRSA infections include those with decreased immunity, health care workers, or those confined to places with large numbers of people.

The Centers for Disease Control and Prevention (CDC) estimates that about 1.7 million institutional infections occurred in the United States annually, with 99,000 associated deaths.

MRSA usually appears with skin lesions and can rapidly progress within 24 to 48 hours of the first symptoms. The first presentation is small red bumps that resemble pimples, spider bites, or boils. Often there is fever and a generalized rash. Within a few days, the bumps become larger and more painful; they eventually open into deep, pus-filled boils. About 75% of community-associated MRSA infections are localized to skin and soft tissue and usually can be treated effectively. MRSA infections that progress to deep tissue or bloodstream infections are very difficult to treat and can be fatal.

It is not known how a person becomes colonized with this organism, but it is thought MRSA can live within the cells of the lining of the nose and tonsils without causing symptoms in the individual. Studies in Great Britain on school-age children found that 2.3% were carriers. Because this has become such a universal problem for hospitals and institutions, nasal cultures are often obtained prior (outpatient procedures) or at the time of admission.

Complete surface sanitation with disinfectants or bleach solution is necessary to eliminate MRSA in areas where patients are recovering from invasive procedures. Testing patients upon admission, isolating and decolonization of MRSA-positive patients, and complete cleaning of patients’ rooms are the current best practice protocols for limiting institutional spread, along with hand washing, use of gloves, etc.

Workers with MRSA infections do not have to be routinely excluded from the general workplace. Unless directed by a health care provider, exclusion from work should be reserved for those with wound drainage that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good hygiene practices. Workers with active infections should be excluded from activities where skin-to-skin contact is likely to occur until their infections are healed.

Both community-acquired MRSA and institutional MRSA are resistant to traditional anti-staphylococcal antibiotics, such as methicillin or cephalexin. Community-acquired MRSA can often be treated with sulfa drugs, tetracyclines and clindamycin. For many, however, vancomycin is needed. This is given intravenously by home IV infusion.

Hospital/institutional-MRSA is resistant even to these antibiotics and often is susceptible only to vancomycin. There are newer drugs now being developed that appear to be effective against treating both community and institutional MRSA and can be given orally.

Careful hand washing is the single most effective way to control the spread of MRSA. Skin infections caused by MRSA should be covered until healed, especially to avoid spreading the infection to others. Family members and others with close contact should wash their hands frequently with soap and water. Personal items that may be contaminated (towels, razors, clothing, etc.) should not be shared.

Both the Centers for Disease Control and Prevention (CDC) and the National Collegiate Athletic Association (NCAA) have issued recommendations for preventing the spread of MRSA among athletes. These include practicing good personal hygiene, such as showering after practices and competitions and not sharing personal items such as towels. Athletes who participate in sports where equipment is shared by many are encouraged to use individual equipment and to frequently wipe down equipment/mats with commercial disinfectants or a 1:100 solution of diluted bleach (one tablespoon bleach in one quart water).

[The views presented in The River Reporter’s health features are those of the authors, and are provided for general information only. They should not be taken as a substitute for consultations with your physician or a local treatment center, or as prescribing treatment.]