MRSA in Orthopedic Practice and MRSA Screening

MRSA in Orthopedic Practice and MRSA screening

Background

Methicillin-resistant Staphylococcus aureus (MRSA) was first discovered in England in 1961 (Jevons, 1961, p.124-125), and since then has been a global issue. Methicillin resistant Staphylococcus aureus (MRSA) often develops the resistance against various classes of antibiotics. In hospitals, usually colonized or infected healthcare workers are responsible for transmission of MRSA to others (Public Health Division, 2007). MRSA not only causes infections of the bones and joints, but it also affects the lungs, and the urinary tract, ultimately leading to bacteremia, and osteomyelitis. MRSA gained from the hospital setting is usually resistant to all antibiotics except ß-lactams (Nicolle,2006, p.145-146).

In order to amplify the significance of nosocomial infection, the Department of Health in the United Kingdom initiated mandatory surveillance schemes for both MRSA bacteriemia and surgical site infection (SSI) in orthopedic surgery between the year 2001 and 2004, respectively (Health Protection Agency, 2004). The aim of this literature review is to scrutinize the escalating issue of infection with MRSA and its impact on the economy. This literature review uses the information regarding existing practice done in Britain combined with additional recommendations on techniques of decreasing rates of infection in orthopedics practice and trauma.

The contemporary issue

For past 15 years, the prevalence of MRSA has increased threefold (Abbasi, 1998) (Stefani, 2003). The prevalence of MRSA varies according to the region. The least affected countries to be targeted are The Netherlands, Germany and Scandinavia; whereas, Italy and Turkey are the most affected, with France and the United Kingdom in the middle. Since 1999, The European Antimicrobial Resistance Surveillance System (EARSS) habitually gathers antimicrobial susceptibility to Staph. Aureus testing data produced from more than 700 laboratories of around 1100 hospitals in 28 European countries. As a result, it was seen that between, 1999 and 2002, a considerable increase in the prevalence of MRSA (p < 0.05) was observed in Austria, Belgium, Germany, and the UK.

For the past three years, there was approximately 40% stagnant development in the number of staphylococcal infections. Currently, a 3.6% increase in the rate of MRSA bacteraemias was observed (HPA, 2004).

Despite the lack of availability of data, it is noted that MRSA tends to occur more in orthopedic patients. De Lucas-Villarrubia et al (2004) in his study observed that the prevalence of MRSA in an orthopedic department was 1.6% compared to the 0.3% in a general hospital environment. Similarly, Tai et al. (2004) observed that 1.6% of the total orthopedic patients admitted in the London teaching hospital were either infected with or colonized by the infection. On the other hand, Fluit et al. (2001) observed that despite the reduction in the staphylococcal infections within an orthopedic setting as compared to the ICU, the intensity of methicillin resistance was still elevated.

MRSA - genetics and transmission

Staph. aureus developed a resistance to Methicillin resistance due to the presence of an acquired penicillin-binding protein, PBP2a. The gene mecA encodes PBP2a and is present on the staphylococcal chromosomal cassette. Staphylococci's extent of resistance depends upon the ...