What is MRSA?

Staphylococcus aureus, or "staph" bacteria normally reside on the skin and nose and are usually harmless. Most individuals do not manifest any symptoms of illness; however due to its prevalence, this pathogen is a common culprit of hospital-acquired infection. Acute skin infection may even develop due to drug resistance. Methicillin-resistant Staphylococcus aureus, more commonly referred to as MRSA, is a bacterial organism resistant to many antibiotics, in particular the -cillins.¹ The overuse and misuse of antibiotics in the past several decades has contributed to its resistance to certain antibiotics. The most common cause of MRSA is group A Streptococcus.¹ The most common type of MRSA is community-associated, although MRSA can by contracted in a health care setting such as dialysis centers and long term care facilities.² Although the most common area affected by MRSA is the skin, MRSA can also infect other areas of the body in more severe cases such as the bones, joints, lungs, and heart.

How Does Someone Contract MRSA?

Cases of MRSA infection are most commonly noted in areas where patients have close contact or share certain items, or if they have a weakened immune system.³ MRSA can live on surfaces such as clothing, sporting equipment, utensils, etc, for several hours. The most common way for the bacteria to enter the body is direct contact through an opening in the skin with an infected surface.¹ Living in community settings such as long term care facilities, prisons, camps, etc can increase a patient’s risk of contracting MRSA. Those with immunity issues are at a higher risk of contracting MRSA in any setting.

What Are the Signs and Symptoms of MRSA?

MRSA is not easily diagnosed as it may be initially diagnosed as cellulitis or other inflammatory issues in the skin. There are several forms of infection that MRSA can be responsible for, including⁴:

• Tissue and Skin infections (Impetigo, Abscesses, etc)
• Urinary Tract Infections
• Bone and joint infections
• Respiratory Tract Infections

The skin may present with an ulceration or blister that is warm to the touch, with or without drainage, and can deteriorate rapidly.² The patient may also develop systemic symptoms such as fever, chills, and headache, although these are not always common. MRSA is diagnosed by obtaining a thorough history of the symptoms, as well as a culture of the affected area.

What Is the Treatment for MRSA?

Milder infections are treated with oral antibiotics that are indicated as effective by the culture. More severe infections or infections that are sensitive to only certain antibiotics administered by IV may require hospitalization. In some severe cases, the area may need to be incised and drained or may require surgical debridement. Prolonged untreated MRSA can lead to more severe conditions such as a deeper infection or abscess, blood infection, or infection of other organs.^1,4

What Is the Best Way to Prevent MRSA?

Wound care professionals should ensure good handwashing with soap and water for a least 20 seconds. If soap and/or water are not available, hand sanitizers are a safe substitute unless hands are visibly soiled. Always keep wounds cleaned and covered at least daily. Do not share personal items such as towels, razors, sheets, and workout clothes. Immunocompromised patients or those at risk should be advised to clean surfaces in public gyms with disinfectant prior to working out. Athletes in close contact sports such as wrestling should shower immediately after, and clothing should be washed after each activity. Linens in a shared community setting should be washed with hot water and dried in a hot dryer.^1-4

The most important factor in the prevention of MRSA is proper utilization of antibiotics. Overuse of antibiotics contributes to MRSA. Always make sure that an antibiotic is warranted prior to prescribing and review the amount, type, and time span of antibiotics taken in the past. Advise patients to complete any prescribed antibiotics. MRSA infections usually clear with time and treatment.¹

References

1. Methicillin-Resistant Staphylococcus Aureus (MRSA). Cleveland Clinic. Updated January 19, 2021. https://my.clevelandclinic.org/health/diseases/11633-methicillin-resist….
2. MRSA Infection. Mayo Clinic. Published Nov. 8, 2022. https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc….
3. Methicillin-resistant Staphylococcus aureus (MRSA). CDC. Updated February 5, 2019. https://www.cdc.gov/mrsa/index.html.
4. Brown NM, Goodman AL, Horner C, Jenkins A, Brown EM. Treatment of methicillin-resistant Staphylococcus aureus (MRSA): updated guidelines from the UK. JAC Antimicrob Resist. 2021; Doi:10.1093/jacamr/dlaa114.

About the Author

Cathy Harmon, DNP, MSN, FNP-BC, CWON, CFCN is a Nurse Practitioner at the VA Medical Center in Lake City, Florida. She is the Wound Care Provider in the Out-Patient Clinic serving the Veteran Population of North Florida and South Georgia. Cathy is certified in wound, ostomy and foot care. In addition to her wound care experience, she also has experience in acute care, pediatrics, home health, long-term care and has served as a Professor of Nursing. Cathy’s passion for wound care began while she was working in the long-term care setting as an RN. She serves the veteran population as a memorial to her dad, a combat wounded WWII Veteran.