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The Epidemiology of Community Associated MRSA: Ca-MRSA has grown during the past 5-15 years

By: Medical Leader Staff/Press Release/Other See more articles by Medical Leader Staff/Press Release/Other Published: 06/16/2007

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BY JANIE HALL ANDTERESA EPLING
For the Medical Leader

PIKEVILLE — MRSA (Methicillin-Resistant Staphylococcus Aureus) is a growing concern in the community today. MRSA is the most common cause of soft tissue infection. It causes 90 percent of bone and joint infections and can cause blood stream infections and sepsis. Approximately one-third of the population has Staphylococcus Aureus.

MRSA is resistant to certain antibiotics such as penicillin, cephalosporin (Rocephin) and Clindamycin. MRSA is seen in sepsis, pneumonia, skin or bone diseases in people with significant underlying illnesses.

Community Acquired MRSA (CA-MRSA) causes diseases in the healthy population. CA-MRSA has become prominent nationally in the last five to 10 years. With CA-MRSA there is no association with hospital exposure. It seems to have unique properties that make it more virulent than regular Staphylococcus Aureus. CA-MRSA acts very quickly. It is of the utmost importance to receive the appropriate treatment options if diagnosed with this, such as Bactrium, Septra, Rifampin, Zyvox or Vancomycin. Abscesses tend to form with pockets of infection that require surgical drainage in addition to antibiotic therapy. Incision and drainage may be performed to obtain a culture to identify the most appropriate antibiotic.

CA-MRSA produces a toxin called Panton- Valentine. This toxin damages the membranes of most defense cells and erythrocytes. CA-MRSA is much more progressive, especially in soft tissue.

Community Acquired MRSA may be easily overlooked due to its presentation. This may appear to be a “spider bite” or a “boil.” The skin may be red, swollen, pus-filled and, or, irritated. Often patients experience multiple hospital visits prior to definitive treatment. You may have to be hospitalized for one to two days, depending on the severity of illness.

Methicillin Resistant Staphylococcus Aureus’ colonization can last for months or years. Colonization is most common in the nose and skin. Colonization means the person has the bacteria in their system, but they do not show any signs of infection or sickness. Treatment for colonization regimens may include 1 percent bleach baths, bactroban ointment to the nares, Cholorhexedine glucunate showers or hibiclens baths. Recent studies suggest adding oral antibiotics at higher doses to the regimen.

Repeat episodes are not uncommon. Entire families can be affected by CAMRSA more often than regular Staphylococcus Aureus. Antibiotic therapy does not prevent this from happening. Outbreaks have been noted in close groups such as homes, jails, athletic teams, prisons and coal mines. CA-MRSA is transmitted more easily due to the close contact, sharing of equipment and, or, machines. Athletes are part of the community and are part of the increase in CAMRSA.

Athletes have skin abrasions as part of their sport and have direct contact with others, share equipment and surfaces contacted by other athletes.

Athletes can serve as a transmission in the athletic environment. They may think the skin infections are not serious enough to seek medical attention and it progresses rapidly to abscesses, invasive cellulitis or even necrotizing fasciitis.

One to five percent of the population harbor MRSA as normal flora in the nose. This spreads by touching their face or nose with their hands to the environmental surfaces they come in direct contact with. If an athlete has broken skin, this may lead to the infection. Specific practices linked to CA-MRSA transmission is sharing of towels, razors, soap, deodorant, and frequency of showers and sharing of clothing.

In conclusion, whirlpools, shared equipment of any kind, locker rooms or other contaminated surfaces need to be cleaned with an appropriate disinfectant such as household bleach.

Hand washing is the most effective way to reduce transmission of CA-MRSA. Wash hands with soap and water or an alcohol hand sanitizer. An aggressive approach to the management of CA-MRSA can be effective.

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