MRSA as a Public Health Concern in Medical Facilities: Difference between revisions

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What is MRSA and why does it present a unique threat to public health?
Edited by Tommy Brown
== Introduction ==


Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph infection that is especially resistant to a wide number of antibiotics, including methicillin, oxacillin, penicillin and amoxicillin.   As with most multi-drug resistant pathogens, MRSA is difficult to combat once contracted because the normal regimen of drugs does not work.  With the increased use of antibiotics, with a number of different pathogens there has been seen an increase in drug-resistant strains, such as with MRSA, Tuberculosis and [?].  Many credit the overuse of antibiotics as the main cause for this increase in resistance, but as is discussed below, there are a number of compounding factors.   
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph infection that is especially resistant to a wide number of antibiotics, including methicillin, oxacillin, penicillin and amoxicillin. [1].  As with most multi-drug resistant pathogens, MRSA is difficult to combat once contracted because the normal regimen of drugs does not work [expand].  With the increased use of antibiotics, with a number of different pathogens there has been seen an increase in drug-resistant strains, such as with MRSA, Tuberculosis and [?].  Many credit the overuse of antibiotics as the main cause for this increase in resistance, but as is discussed below, there are a number of compounding factors.
In addition to the resistant nature of MSRA, there has also been an observable increase in number of cases.  A study done over the past seven years has shown a significant increase of MRSA in hospitals, from 4.5/10,000 in 2002 to 19/10,000 in 2009 .  This is especially dangerous due to the fact that MRSA frequently presents itself in hospital environments, where there is a significantly more vulnerable population than the general public, which combined with the fact that nearly half of all in-patients and almost all intensive care unit patients are on some form of antibiotics  leads to increased resistance to antibiotics.
Acquiring MRSA has been associated in two different environments: community-acquired MRSA (CA-MRSA) and health care-acquired MRSA (HA-MRSA).  This article’s focus is on HA-MRSA, to learn more about CA-MRSA, click here.  The Center for Disease Control defines HA-MRSA “in persons who have had frequent or recent contact with hospitals or healthcare facilities (such as nursing homes or dialysis centers) within the previous year, have recently undergone an invasive medical procedure, or are immunocompromised,”  [2].  HA-MRSA constitutes 85% of all MRSA infections in the United States [2] and there has also been an observable increase in number of cases.  A study done over the past seven years has shown a significant increase of MRSA in hospitals, from 4.5/10,000 in 2002 to 19/10,000 in 2009 [3].
MRSA presents a unique threat to public health for a number of reasons.  First and foremost, it reinforces the importance of maintaining a sterile and sanitary environment in hospital-settings to protect those that have open wounds, are immunosuppresed or have had their immune systems otherwise weakened.  Second, MRSA has shown an increasing resistance [?] to nearly all forms of antibiotics, causing many to term it a ‘superbug’ because it has become increasingly difficult to combat.
There is some light at the end of the tunnel, however.  Many public health officials have pointed out how easy it is to protect against MRSA in hospital settings, mostly by maintaining standard sanitary procedures.


How did MRSA evolve in to the multi-drug resistant strain it is today?
== MRSA in the context of health care ==


Since the discovery of penicillin and other antibiotics, there was a significant period of time when antibiotics were viewed as ‘cure-alls’ for infection, and “there was a feeling of complacency between the 1940s-190s, with a misplaced belief that available antibiotics would always effectively treat all infections,” .  However, the over-prescription of antibiotics, especially in cases where the person would have likely beat the infection on their own anyway, led to an increase in resistance to the normal regimen of antibiotics, most notably methicillin, oxacillin, penicillin and amoxicillin.
===Why HA-MRSA is unique ===
Due to the opportunistic nature of MRSA, health care environments present a unique risk for spreading and contracting the disease.  Many patients in hospitals have either open wounds or breaks in the skin such as intravenous lines (IVs) and catheters that leave them especially susceptible to infection.  Additionally, nearly half of all in-patients and almost all intensive care unit patients are on some form of antibiotics , reducing the body’s natural flora found on the skin which works as a natural barrier to the disease, compounding their vulnerability to the disease. 
The most common ways to contract MRSA in a health care environment are contact, whether direct or indirect, with a contaminated object, infected person or with someone that is colonized by the disease but not infected.  It is estimated that between 2-7% of the US population are colonizers of MRSA [6], and thus without proper care for maintaining a sanitary and sterile environment, it is relatively easy for someone that is immunocompromised or otherwise vulnerable to contract the disease upon exposure to it.  One has the ability to infect someone without themselves presenting any symptoms, making MRSA a dangerous threat in a medical environment because it is possible for health care personnel to be carriers for the disease without them knowing.


-Talk about people not following through on their drug therapies, allowing populations of bacteria to rebound, now resistant to that antibiotic
=== How HA-MRSA presents itself ===


What are the public health recommendations for combating MRSA?
MRSA generally enters the body through openings in the skin, such as cuts or openings for an IV.  As a result, the first signs and symptoms of infection are similar to that of a normal skin infection, such as swelling, puss, redness and sensitivity.  However, as the disease progresses more systemic symptoms begin to appear such as fever, pneumonia, bacteremia (infection of the bloodstream), sepsis and if left untreated, organ failure and death.  This is not to say that all MRSA infections lead to death, but if left untreated and allowed to go systemic, MRSA can present serious complications beyond a normal skin infection.  This is especially the case with HA-MRSA due to the fact that it strikes those who are already immunocompromised or vulnerable.

Revision as of 21:24, 7 December 2009

Edited by Tommy Brown

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph infection that is especially resistant to a wide number of antibiotics, including methicillin, oxacillin, penicillin and amoxicillin. [1]. As with most multi-drug resistant pathogens, MRSA is difficult to combat once contracted because the normal regimen of drugs does not work [expand]. With the increased use of antibiotics, with a number of different pathogens there has been seen an increase in drug-resistant strains, such as with MRSA, Tuberculosis and [?]. Many credit the overuse of antibiotics as the main cause for this increase in resistance, but as is discussed below, there are a number of compounding factors. Acquiring MRSA has been associated in two different environments: community-acquired MRSA (CA-MRSA) and health care-acquired MRSA (HA-MRSA). This article’s focus is on HA-MRSA, to learn more about CA-MRSA, click here. The Center for Disease Control defines HA-MRSA “in persons who have had frequent or recent contact with hospitals or healthcare facilities (such as nursing homes or dialysis centers) within the previous year, have recently undergone an invasive medical procedure, or are immunocompromised,” [2]. HA-MRSA constitutes 85% of all MRSA infections in the United States [2] and there has also been an observable increase in number of cases. A study done over the past seven years has shown a significant increase of MRSA in hospitals, from 4.5/10,000 in 2002 to 19/10,000 in 2009 [3].

MRSA in the context of health care

Why HA-MRSA is unique

Due to the opportunistic nature of MRSA, health care environments present a unique risk for spreading and contracting the disease. Many patients in hospitals have either open wounds or breaks in the skin such as intravenous lines (IVs) and catheters that leave them especially susceptible to infection. Additionally, nearly half of all in-patients and almost all intensive care unit patients are on some form of antibiotics , reducing the body’s natural flora found on the skin which works as a natural barrier to the disease, compounding their vulnerability to the disease. The most common ways to contract MRSA in a health care environment are contact, whether direct or indirect, with a contaminated object, infected person or with someone that is colonized by the disease but not infected. It is estimated that between 2-7% of the US population are colonizers of MRSA [6], and thus without proper care for maintaining a sanitary and sterile environment, it is relatively easy for someone that is immunocompromised or otherwise vulnerable to contract the disease upon exposure to it. One has the ability to infect someone without themselves presenting any symptoms, making MRSA a dangerous threat in a medical environment because it is possible for health care personnel to be carriers for the disease without them knowing.

How HA-MRSA presents itself

MRSA generally enters the body through openings in the skin, such as cuts or openings for an IV. As a result, the first signs and symptoms of infection are similar to that of a normal skin infection, such as swelling, puss, redness and sensitivity. However, as the disease progresses more systemic symptoms begin to appear such as fever, pneumonia, bacteremia (infection of the bloodstream), sepsis and if left untreated, organ failure and death. This is not to say that all MRSA infections lead to death, but if left untreated and allowed to go systemic, MRSA can present serious complications beyond a normal skin infection. This is especially the case with HA-MRSA due to the fact that it strikes those who are already immunocompromised or vulnerable.

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