MRSA, Bella Wesmiller, Microbiology

MRSA

MRSA

Purpose

The BOP Clinical Practice Guidelines for the Management of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections provide recommendations for the prevention, treatment, and containment of MRSA infections within federal correctional facilities.

Epidemiology

MRSA infections are traditionally associated with exposure to a health care environment, especially the inpatient hospital setting. However, MRSA has newly evolved to include bacterial strains affecting persons without previous exposure to health care environments. These community-associated MRSA (CA-MRSA) infections have been identified in a variety of populations, including: athletes participating in close contact sports, military recruits in barracks settings, intravenous drug users, men who have sex with men, tattoo recipients, religious community members, and inmate populations. Moreover, many healthy adults and children—without any obvious risks for exposure—are also developing MRSA infections. In most communities in the U.S., MRSA is the leading cause of skin and soft tissue infections (SSTIs) among persons seeking emergency care. Risk components for MRSA are recorded in Table 1.

Table 1. Risk components that Should boost doubt for MRSA Infection

Clinical Presentation

The range of disease caused by CA-MRSA is similar to that caused by CA-methicillin sensitive Staphylococcus aureus (MSSA). The most widespread lesions are abscesses and cellulitis. Frequently, abscesses are accompanied with an area of central necrosis. Furuncles (boils) are also common, particularly in the context of a MRSA outbreak. Frequently MRSA infections are reported by patients to be ?spider bites.? This is not because a spider bite has actually occurred, but because CA-MRSA lesions often have a similar appearance to a spider bite—a raised red tender lesion that may progress to develop a necrotic center. Fever, leukocytosis, and systemic signals of inflammation are often absent. Less commonly—but not infrequently—CA-MRSA presents as: impetigo, folliculitis, deep-seated abscesses, pyomyositis, osteomyelitis, necrotizing fasciitis, staphylococcal toxic-shock syndrome, pneumonia, and sepsis. Serious systemic infections are more common among persons with a history of injection drug use, diabetes, or other immunocompromising conditions. (Baillargeon 2004)

Transmission

Aprime mode of transmission of MRSA is person-to-person by contaminated hands. MRSA may also be transmitted by sharing towels, personal hygiene items, and athletic equipment; through close-contact sports; and by sharing tattoo or injection drug use equipment. Persons with MRSA pneumonia who are in close contact with others can potentially transmit MRSA by coughing up large droplets of infectious particles that can contaminate the environment. Persons with asymptomatic MRSA nasal carriage can also transmit MRSA, especially when symptomatic from a viral upper respiratory infection. MRSA can also cause a toxin-mediated, food borne gastroenteritis. (Baillargeon 2004)

Principles of SSTI Diagnosis and Treatment

Specific steps for assessing and treating SSTIs are delineated in part 5 and in Appendix1. General principles regarding diagnosis and treatment are discussed below.

Diagnosis

Avery cautious persevering annals and skin examination should be presented. The decision about obtaining a wound culture is based upon the following considerations:

Empiric Diagnosis

The diagnosis of a probable MRSA SSTI can be made empirically—without culture confirmation—for inmates who present with an SSTI within the context of a known MRSA outbreak, or when periodic surveillance of SSTIs ...