Racial Disparities in MRSA Infections: Difference between revisions

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==Health Effects of MRSA==
==Health Effects of MRSA==
Photograph depicted a cutaneous abscess on the hand, which had been caused by methicillin-resistant Staphylococcus aureus bacteria, referred to by the acronym MRSA.
[[Image: MRSAabscess.jpg|thumb|300px|left| Photograph shows an abscess caused by methicillin-resistant Staphylococcus aureus bacteria on the arm of a Black patient. Photo credit belongs to Public Health Image Library. [https://www.cdc.gov/mrsa/community/photos/photo-mrsa-5.html CDC].]]
 
MRSA is responsible for causing a broad myriad of potential negative health outcomes. These conditions include sepsis syndrome, toxic shock, skin and soft tissue infections,
bacteremia and endocarditis, pneumonia, bone and joint infections, CNS disease, and bacteremia. ​</ref name=mrsaconditions> [https://doi.org/10.1093/cid/ciq146 Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF; Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55. <ref> Of note, bacteremia is present in roughly 75% of invasive MRSA cases. <ref name=mrsaconditions/>
 
The wide spectrum of illness caused by MRSA includes SSTIs,
bacteremia and endocarditis, pneumonia, bone and joint infections, CNS disease, and toxic shock and sepsis syndromes.
CA-MRSA was the most common cause of SSTI in a geographically diverse network of emergency departments in the
United States [11]; however, there may be differences in local
epidemiology to consider when implementing these guidelines.
SSTIs may range in clinical presentation from a simple abscess
or cellulitis to deeper soft-tissue infections, such as pyomyositis,
necrotizing fasciitis, and mediastinitis as a complication of retropharyngeal abscess [12–15]. Bacteremia accompanies the
majority (75%) of cases of invasive MRSA disease [5]. A multitude of disease manifestations have been described, including,
but not limited to, infective endocarditis; myocardial, perinephric, hepatic, and splenic abscesses; septic thrombophlebitis
with and without pulmonary emboli [16]; necrotizing pneumonia [17–21]; osteomyelitis complicated by subperiosteal abscesses; venous thrombosis and sustained bacteremia [16, 22,
23]; severe ocular infections, including endophthalmitis [24];
sepsis with purpura fulminans [25]; and Waterhouse-Friderichsen syndrome [26].


==Hospital and Healthcare Associated MRSA==
==Hospital and Healthcare Associated MRSA==

Revision as of 00:10, 9 April 2021

MRSA Overview

Image taken from a colorized scanning electron micrograph (SEM) magnified at 20,000X depicting a grouping of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Photo credit belongs to Public Health Image Library. CDC.


Methicillin-Resistant Staphylococcus aureus, or MRSA for short, is a Gram-positive cocci-shaped (spherical) bacterium that measures approximately 1μm in diameter and forms clusters that are popularly described as being grape-like. [1] S. aureus is present on and within the bodies of many individuals asymptomatically, and as a result of this it often remains unnoticed. According to studies around 20% of people are persistent nasal carriers of S. aureus and around 30% are intermittent carriers, with the remaining 50% not carrying the bacterium. [1] Other than within the nose, S. aureus can be commonly seen present on the skin, skin glands, guts, and a variety of mucous membranes. This presence within the body is referred to as colonization, and it significantly increases the chances of acquiring an infection by providing a reservoir of the pathogen. [1] In most cases, the previously asymptomatic, commensal S. aureus that previously colonized the microbiome of individuals is responsible for their infection. [2] Within the world of public health and medicine, a hugely important factor associated with S. aureus is its significant level of acquisition of resistance against multiple antibiotic classes, which greatly complicates efforts to treat it clinically. [3] Methicilin is an antibiotic class of particular interest with regard to resistance acquisition among S. aureus. According to the latest CDC data released in 2019, Methicillin-Resistant Staphylococcus aureus and other, less prominent strains of S. aureus accounted for an estimated 119,247 bloodstream infections within the United States in 2017, while causing 19,832 of those infected to pass away from complications associated with infection. [4]


As shown in the number of cases within 2017 alone given above, infections due to MRSA are a widespread phenomenon, however, there are stark differences in the incidence rates between different races in the US, particularly amongst Black and White people. [5] [6] It is speculated that these disparities are the result of the combined effects of socioeconomic inequalities, socio-environmental inequalities and broader disparities in the overall prevalence of certain health factors between races, for instance, diabetes. [5]



Health Effects of MRSA

Photograph shows an abscess caused by methicillin-resistant Staphylococcus aureus bacteria on the arm of a Black patient. Photo credit belongs to Public Health Image Library. CDC.

MRSA is responsible for causing a broad myriad of potential negative health outcomes. These conditions include sepsis syndrome, toxic shock, skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, CNS disease, and bacteremia. ​</ref name=mrsaconditions> Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF; Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55. Cite error: Closing </ref> missing for <ref> tag ]

Community-Associated MRSA

MRSA cases by race, stratified by quartiles of US census data pertaining to income, housing, education, and health. Cases are depicted in increasing quartiles of census data, per 100000 persons for white (white bars) and black (black bars) persons. Figure credits belong to the authors of the cited paper. [7]

Section 4

Include some current research, with at least one figure showing data.

References

  1. 1.0 1.1 1.2 Lakhundi, S., & Zhang, K. https://doi.org/10.1128/CMR.00020-18 "Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology." 2018. Clinical microbiology reviews, 31(4), e00020-18.
  2. Rhonda Griffiths, Ritin Fernandez, Elizabeth Halcomb "Reservoirs of MRSA in the acute hospital setting: A systematic review" 2002. Contemporary Nurse, 13:1, 38-49
  3. Ventola, C Lee. “The antibiotic resistance crisis: part 1: causes and threats.” 2015 P & T : a peer-reviewed journal for formulary management vol. 40,4: 277-83.
  4. Kourtis AP, Hatfield K, Baggs J, et al. "Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections — United States." 2019 MMWR Morb Mortal Wkly Rep 2019;68:214–219.
  5. 5.0 5.1 Cite error: Invalid <ref> tag; no text was provided for refs named gualandiclass
  6. Ali F, Immergluck LC, Leong T, Waller L, Malhotra K, Jerris RC, et al.. A Spatial Analysis of Health Disparities Associated with Antibiotic Resistant Infections in Children Living in Atlanta (2002–2010). eGEMs (Generating Evidence & Methods to improve patient outcomes). 2019;7(1):50.
  7. Isaac See, Paul Wesson, Nicole Gualandi, Ghinwa Dumyati, Lee H. Harrison, Lindsey Lesher, Joelle Nadle, Susan Petit, Claire Reisenauer, William Schaffner, Amy Tunali, Yi Mu, Jennifer Ahern "Socioeconomic Factors Explain Racial Disparities in Invasive Community-Associated Methicillin-Resistant Staphylococcus aureus Disease Rates" 2017. Clinical Infectious Diseases, Volume 64, Issue 5, 1 March 2017, Pages 597–604.