What is MRSA?
Methicinillin-Resistant Staphylococcus aureus (MRSA) is a bacteria that is very resistant to antibiotics. This means that conventional antibiotic medications prescribed by doctors to treat regular staph infections are not effective against MRSA. By definition there are two types of MRSA. Hospital acquired MRSA (HA-MRSA) and Community acquired MRSA(CA-MRSA). Both are the same bacteria but they may differ slightly within their genetic makeup.
Where did MRSA come from?
MRSA has been around since the 1960’s but the big spread happened in the early 1980’s. It is a global issue and the United States has a large percentage of the infectious population. The main goal of a bacteria is to live and multiply. MRSA evolved and mutated so that regular penicillins could not kill the bacteria. One theory is that penicillins and antibiotics in general are over prescribed and this caused the emergence of MRSA. Now doctors work very closely with infectious disease medicine to ensure proper antibiotic usage.
Who is susceptible to MRSA?
Patient’s who have stayed or been treated at hospitals, nursing homes, long term care facilities are at a higher risk of acquiring HA-MRSA. The longer the duration of stay the more the risk. Patient’s who have undergone major joint replacement or any surgery are also at an increased risk.
People who contract CA-MRSA are typically those who have skin to skin contact with other infected individuals. Wrestlers, football players, child care workers, and anyone who lives in a crowded condition have a higher prevalence of CA-MRSA.
What are the symptoms of a MRSA infection?
In general MRSA looks like a small painful pimple or little red bumps. If popped there is often a puss like discharge and they are also warm to the touch. These symptoms are also common with a regular staph infection of the skin. In the office we see MRSA most commonly in leg and foot wounds. The area of the wound is typically painful, red, swollen, and has drainage. This infection can spread quickly to underlying tissue such as the muscle, bones, and blood of the patient and therefore if any of these symptoms are seen please consult a physician immediately.
Advance imaging such as X-rays and magnetic resonance imaging (MRI) are used to see if there is any boney involvement of the infection or if a deep abscess is present at the site of the infection. These imaging modalities also help to determine whether or not surgical intervention is warranted to cure the infection.
How do we test for MRSA?
The most common testing method for MRSA is by performing a thorough clinical exam and also attaining a culture. According to the infectious disease guidelines if there is a wound with suspected MRSA infection the culture should be a deep culture and not a simple swipe of the wound. This is because on the surface of the skin there is generally all kinds of bacteria including MRSA. Bacteria exists every where but our bodies know how to defend against it. Sometimes the bacteria can cause an actual infection and result in pathology for the patient and this is why superficial cultures are ineffective. To find the real infective agent one must attain a deep culture of the wound or at least the discharge occurring from the wound. Once the culture is sent the bacteria type and the antibiotics that will work against it are identified. If the infection is present in the blood or bone then a culture of the blood/bone will be necessary for determine the infectious agent.
How do we treat MRSA?
Once the cultures are attained the type of antibiotic that should be used is identified. The decision the doctor needs to initially make is whether or not the infection can be treated with regular oral antibiotics or intravenous (IV) antibiotics. IV antibiotics are a stronger type of antibiotic since it is administered directly into the blood stream. Oral antibiotics are effective but can be slower to rid the infection. Another factor of healing with antibiotics is the circulation of the patient. If the blood flow to the infection is limited then the amount of antibiotic to the site of infection will be small. If this is the case then a vascular surgeon may perform a procedure to improve blood flow to the lower extremities.
If the MRSA infection presents as an abscess then the draining of the abscess is the most effective treatment. Excising the infection from the skin is a very effective way of treating lower extremity infections. Typically we will see a wound that is puss filled with a deep abscess and the surgeon will use sharp instrumentation in the operating room and remove all of the necrotic and infected tissue. The wound will then be dressed with a sterile dressing and antibiotics will be given for a few weeks. Patient’s who undergo this type of procedure recover very well assuming no other health problems are inhibiting their healing.
If the MRSA infection is in the bone we have two options to treat. First we can try to treat with IV antibiotics for six weeks and see if the boney infection is improved. Or we can amputate the infected bone and surrounding soft tissue. Although this treatment seems severe it is necessary in order to avoid spreading of the infection to the blood and adjacent areas of the body. If we can amputate a toe to save a foot or a leg then that is considered a success. Limb salvage is a very important component of podiatric surgery and it is not taken lightly. Doctors have to constantly weigh the risk/benefit of their actions in order to attain the most favorable outcomes for their patient’s.
How do we prevent a MRSA infection?
In the hospital and health care setting it is necessary that every person entering a patient room takes proper precautions to not spread bacteria. Frequently washing of hands and using proper contact precautions such as gloves and gowns are necessary in protecting all the patients and staff of the facility. Many times when I am seeing inpatients I see five or six family members present at the bedside of the patient. All are there with good intentions of love and support but they neglect to practice proper infectious disease precautions. If a patient in the hospital is diagnosed with an infectious agent then proper contact precautions are initiated. This means that anyone who comes into contact with the patient is to use the supplied gowns, masks, and gloves when in the room of the patient. Of course the wall units with the antibacterial hand solution should be utilized upon entering and exiting the patient room. The supplied gown, mask, and gloves should also be removed before leaving the patient room. Healthcare facilities that practice these methods have a significant decrease in the spread of resistant bacterias such as MRSA.
In the community the simple acts of good hand washing, keeping wounds clean and covered, not sharing personal items, showering after athletic activity, and keeping linens clean can be very effective in reducing the risk of infection. The main take home point is that one should practice good hygiene and avoid sharing other people’s personal items.
The prevention of MRSA and other resistant bacteria is a joint effort of hospital staff and the community as a whole. We each need to do our part in order to help prevent the spread of these infectious agents so that we can prevent these difficult infections. If you or a loved one have these symptoms or have an open wound please do not hesitate to see a healthcare provider. The doctors of Advanced Podiatry are well versed in the treatment of MRSA and other infectious agents and also work closely with infectious disease doctors to treat the infection efficiently. Call (813) 875-0555 and schedule an appointment today.