MRSA


Hello, my name is Dr. Jairo Cruz Jr., and I’m a podiatrist at Advanced Podiatry. Today, I’m going to be talking about MRSA or Methicillin-resistant Staphylococcus aureus which is a bacteria that is commonly feared amongst the public as being a very harmful and possibly deadly bacteria to people.

I want to dispel some myths and I wanted to educate the population on this type of bacteria, so that they can better understand why it came about and how to prevent it, and what the risk factors are for this type of infection.

Essentially, MRSA is a type of bacteria this is resistant or basically does not get killed off by certain antibiotics such as penicillin. Back in the day, the early sixties, is when we started to see an uptick in MRSA infections.

And in the eighties, it really spread across globally. Now, in the United States, it’s pretty much a common prevalence in at least the hospital setting and also in outpatient settings as well.

MRSA, again, is a bacteria and it is resistant to all penicillin and therefore has to be treated in a certain way in order to get rid of it. typically, the two types of MRSA are community acquired MRSA and hospital acquired MRSA.

Both are based on location of where you contract the infectious agent. If you’re in the community and you’re involved in contact sports such as football or wrestling, or live in a congested or overcrowded community or household, you have a higher risk of prevalence since skin to skin contact is increased and personal items that are used, you’re often exposed to other people’s infections, and therefore especially infection can spread rapidly throughout that type of setting.

Again, skin to skin to contact and also contact with infected material such as towels or any kind of personal items—razor blades, things of that nature—can increase the risk of getting community acquired MRSA.

Hospital acquired MRSA is specific to healthcare settings. For instance, long term care facilities, or nursing homes, or hospitals in general do have a prevalence of MRSA. It can also be spread from patient to patient or room to room if certain precautions are not taken.

Hospital acquired MRSA can be different on a genomic level or a DNA level compared to community acquired MRSA, and therefore sometimes more robust antibiotics such as IV antibiotics are used in the hospital setting as opposed to oral antibiotics which is typically used in an outpatient setting.

Often, I get asked, “Well, why did MRSA come about?” The leading theory is that throughout the history of medicine, antibiotics have been used to cure many different types of bacterial infections but we now know over the past years that bacteria does evolve and can adapt to changes in their environment and also to certain exogenous stimuli like antibiotics.

So, basically, a normal staph infection evolved into MRSA because it wanted to resist the effect of the antibiotic, so that it would carry on reproducing and living.

Blame can be placed on the overuse of antibiotics where antibiotic resistance has increased because of the fact that the antibiotics being used were used so frequently that the bacteria was able to modify itself more rapidly since the exposure to the antibiotic was in greater frequency.

Again, bacteria find a way, the sole purpose in their lives is to multiply, reproduce and carry on. And so, nature finds a way, and therefore the antibiotic resistance to penicillin’s with regards to MRSA came about.

The staph infection, common staph infection of the skin is pretty much a red bump, or a pimple, or a pustule on the skin that’s red and sometimes painful and also warm to the touch. And sometimes, it’s puss filled and will leak. This is for a simple staph infection.
MRSA can also appear this way obviously since it is a type of staph, so that it can appear the same way. Typically, what we see in the office is diabetic foot wounds or any kind of open wound that could be infected by MRSA, and that’s where we see the higher prevalence.

We typically do not see many patients with a simple staph infection of just the pustules or the pimples if you will on their skin. But we do see wounds that are infected with MRSA and therefore we treat them accordingly.

So, how we determine MRSA is quite easy, we take a culture. If it’s the skin, we take a skin culture. If it’s a wound, we take a wound culture. If it’s in the bone or in the deeper tissues, we take a deeper tissue culture or bone culture.

Essentially, what the culture does is it takes whatever bacteria is in that area onto the swab or aspiration or whatever way of collecting the bacterial sample we choose. But typically, it’s a swab and we use it in the area of the wound preferably deeper into the wound as opposed to superficial, so that we can get an accurate diagnosis of what type of bacteria is present.

We then send the sample off to a lab where the pathologist analyzes it and determines what species of what bacteria it is. If it’s MRSA, they will also display—or if it’s any type of specific bacteria—they’ll also tell us what type of antibiotics are effective against it both intravenous or IV and also oral antibiotics.

Once we know what type of bacteria it is and what type of antibiotic we use, the treatment is quite simple. The doctor at this point has to determine whether or not the situation that the patient is in is an emergency situation where they need heavier antibiotics such as IV antibiotics or can the oral antibiotics suffice for the treatment of the pathology?

This is typically determined by symptoms. So, if the patient has a fever, nausea, vomiting, constitutional symptoms where the patient just doesn’t feel well, they feel like they have the flu, in conjunction with a wound or infection of the lower extremity, then typically the podiatrist will say hey let’s send you to the hospital, get some IV antibiotics so we can knock this out quick.

If it’s something localized to the area and somewhat controlled and it’s not spreading up the leg or causing any constitutional symptoms like fever and malaise and flu like symptoms, then we can typically treat as outpatient with oral antibiotics.

Again, that is if oral antibiotics are an option. Sometimes, when we get results, oral antibiotics are not an option because they are not effective against whatever bacteria that may be present in the wound or at the site of the pathology.

So, how do we treat MRSA? Well, that’s simple. Again, the antibiotics, either IV or oral antibiotics, but it depends on the level of infection. Let’s say the infection is deeper to the deep tissues, musculature, and/or bone. Well then, surgical incision of these sites of infection may be warranted because since the disease has already spread to other adjacent parts of the wound or whatever inciting pathology there was, the easiest and most efficient way of getting rid of the bacteria is to cut out the infection. That does sound gruesome, but essentially you have to look at it like is it going to benefit the patient to excise a portion of their tissue in order to prevent spread to the rest of the body? And the answer is usually yes if it warranted.

For instance, let’s say a toe is infected with MRSA in the bone. The MRSA can spread easily to the adjacent bones and therefore you’ll lose 5 toes as opposed to just one or possibly the whole foot or leg.

So, what we do is we explain to the patient what their options are and their options are quite simple. Number one, they can treat with antibiotics, usually IV antibiotics for six weeks to see whether or not the bone infection or whatever deep tissue infection it proves.

And then, if it doesn’t improve in six weeks, then we consider surgical intervention. Again, if it’s a light infection and it’s not required with a hospital stay, oral antibiotics are just as effective.

But nonetheless, if it’s a deep infection or a more severe infection, then surgical intervention may be warranted and therefore all options will be explained to the patient.

And of course, we take into account the sensitivity of the matter of where patients don’t particularly like to hear the word amputation but again, if it’s explained to them that we are trying to provide limb salvage meaning saving of the majority of the limb in order to preserve function and preserve their quality of life, then the patients will understand better as to why this treatment has to occur.

As a foot and ankle surgeon, I try to avoid surgical intervention at all costs just because I know that it’s not easy for the patient to recover from these sorts of treatments. I know there’s an extended recovery time especially with these high-risk patients who come in with diabetic wounds and infections, they don’t heal quite as effectively or quite as efficiently as healthy individuals. And therefore, have to take into account all these factors.

Are they going to be able to heal the surgical intervention?

Will they be able to rehabilitate and be able to walk so that they can resume their quality of life?

Do they have a home setting where it is conducive to healing and do they have the help they need in order to heal the wound at home with limited mobility?

All these factors are considered when talking about surgical intervention of the patient. And therefore, the decision is made not lightly but with a complete grasp of the entire situation both pre-operatively, intra-operatively, and post-operatively, so the patient can achieve the best outcome possible.

How do we prevent MRSA from happening? Well, in community acquired MRSA, we try to avoid poor hygiene. If we are engaging in sports or skin to skin contact with individuals with physical activity, it is wise to wash the body. It’s that simple. If we wash off the bacteria, we can prevent the bacteria from building up its strength and eventually prevent its overcoming of the skin and causing a breakdown in the tissues.
Hand washing, simple but very effective method of preventing any kind of infection, be it MRSA of any other bacterial infection. Proper hand washing and again proper hygiene, and not sharing personal items such as towels, and razors, and toothbrushes, etc. of other people would be an effective way in order to prevent spread of MRSA in the community.

In the hospital setting, it’s a little bit more complicated since there’s a lot of individuals coming in and out of the rooms, and what happens is, is that once MRSA or an infectious agent is determined in a patient, that room is usually then considered to be in isolation.

So, what happens is the patient, if they have a roommate, the roommate gets shuttled out to a different room and then we have contact precautions in place. So, the hospital will provide gowns usually made of plastic, gloves, and then also a mask and possibly a hat to cover the hair in order to protect from coming into contact with the infectious agent of the patient.

The doctors utilize this and obviously we’re also utilizing at the same time the washing of the hands. So, before the doctor or whoever enters the room, they should be washing their hands and before they exit the room they should be washing their hands as well. So, upon entry and exit of the patient room with the infectious agent, they should be washing their hands so as to not spread any kind of infectious agents to other people in the hospital setting.

One of the things that I see in the hospital is that the patient’s family will come in and obviously are there for the love and support of their family member, but what they don’t realize is that if they’re not covering up or if they’re not protecting themselves from coming into contact with the patient with these precautionary devices such as the gown and the gloves, the masks and the headdress, well then they’re causing an increased risk in the traveling of the infection to other individuals within the hospital.

It is annoying. I’m not going to lie, it is annoying to have to put these on every time you visit your relative in the hospital. And for the doctors, it’s annoying as well to have to put on these gowns. It takes time but it takes all but three minutes to put on these precautionary measures and therefore decrease the risk of spreading infection throughout the hospital.

Again, patients and patient’s family members should utilize these precautionary tools in order to prevent the infection spreading from patient to patient.

I hope this video sort of brought a clearer picture to the mystery of MRSA. it’s something that we should absolutely be concerned with and absolutely check out with your doctor if you assume such an infection because it can spread rapidly and especially within immune-compromised patients such as diabetics, it can spread quickly and cause detriment to other portions of the body and possibly the whole body with a systemic infection.

So, therefore if any kind of opening in the skin or blister or pustule is found in the higher or lower extremity, or anywhere, please check it out as soon as possible with your doctor and the doctor will perform the necessary tests in order to determine what the cause of the infection is and therefore render treatment efficiently and effectively.

If you have any questions regarding MRSA, wounds, diabetic wounds, or any kind of infection problems, or if you have a family member or a loved one who does suffer from these types of problems, please make an appointment today at Advanced Podiatry, the number is (813) 875-0555.

The doctors of Advanced Podiatry are very well versed in the treatment of wound care and also infectious disease, and we work closely with several infectious disease teams in order to provide efficient and appropriate care.

Thank you for your time.

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