The surface of the skin of the human body exemplifies the saying that, “looks can be deceiving”. The smooth nature of skin gives the illusion of a 100% bacteria free surface. Through the naked eye, the true scope of the skin’s ecosystem is never truly seen. When taking a closer look though, the surface of the skin is actually teeming with millions of different strains of bacteria, every second of every day. This community of bacteria is home to one of the most well-known species of bacteria, Staphylococcus aureus. Although S. aureus is not life-threatening, another type of staph bacteria is life-threatening. Methicillin-resistant Staphylococcus aureus is a strain of S. aureus that has developed a resistance to multiple types of antibiotics. The first strains of the antibiotic-resistant bacteria were identified by British scientists in 1961. Additionally, the first reported case of a human contracting MRSA in the United States was in 1968 at the Boston City Hospital located in Massachusetts. In the following years, the spread of MRSA became evident, indicating to scientists and healthcare officials that a new danger was on the horizon.
In order to explain the root cause of MRSA, one must discover the practices of healthcare professionals in the 1940s. During that time period, S. aureus infections were overwhelmingly being treated with antibiotics. This can be contributed to the revolutionary discovery of the drug penicillin in 1928. Because of the unsavory combination of antibiotic medicine misuse and overuse, the theory of evolution took hold of the situation. Through the late-1949s and to the 1950s, S. aureus developed a resistance to penicillin. In order to counteract this sudden bacterial evolution, healthcare professionals began to administer methicillin, a different form of penicillin. In 1961 though, British scientists discovered the first strains of the S. aureus bacteria that had a resistance to methicillin. This is sometimes coined as, “the birth of MRSA”. Ever since the discovery of MRSA, the bacteria have developed further resistances to antibiotics. In fact, MRSA is resistant to an entire class of antibiotics, commonly known as beta-lactam antibiotics. Penicillin, methicillin, oxacillin, amoxicillin, cephalothin, and many other antibiotics are a part of this class. Beta-lactam antibiotics treat bacterial infections such as MRSA by inhibiting cell wall synthesis in the bacteria. This leads to osmotic instability or autolysis and eventually, cell death. MRSA is spread by skin contact with the bacteria. This is not limited to direct skin contact with an infected person though, as MRSA can be contracted by touching objects with the MRSA bacteria on them. MRSA infections are found to be more common in immunodeficient people, as well as patients in hospitals, nursing homes, and other healthcare centers. There is also a subdivision of MRSA: Hospital-Associated MRSA (HA-MRSA) and Community-Associated MRSA (CA-MRSA). HA-MRSA is when the infection is contracted in hospitals or in immunodeficient patients. In contrast, CA-MRSA is being increasingly reported. This occurs among people who have not been hospitalized. This has been identified among certain groups of people that have a lot of skin-to-skin contact, such as prison inmates, children in daycare, and teen athletes.
The symptoms of MRSA can vary with which type of infection one contracts, HA-MRSA or CA-MRSA. Patients with HA-MRSA can present with multiple symptoms, such as rash, headaches, chills, fever, fatigue, cough, shortness of breath, and chest pain. Alongside this, contracting HA-MRSA presents a higher chance of causing severe complications, such as pneumonia, urinary tract infections, and sepsis. In contrast, CA-MRSA usually causes skin infections. Rashes and skin infections may be more present in areas with high amounts of body hair or areas that have been cut, scratched, or rubbed. The MRSA infection usually causes a “spider bite-like” swollen and painful bump on the skin. It can have a yellow or white center, and often is surrounded by cellulitis, an area of warmth and increased redness. Pus drainage and fever are also common.
Certain groups of people are at an increased risk of contracting MRSA infections. These risk factors vary depending on the type of MRSA infection that is contracted. People have an increased risk of HA-MRSA infections if they are immunodeficient, have been hospitalized in the past three months, live in a nursing home or other healthcare facility, or frequently undergo hemodialysis. On the other hand, people have an increased risk of CA-MRSA infections if they reside in unsanitary conditions, work at a daycare facility, frequently participate in contact sports, or share towels, razors, or exercise equipment with others. The diagnosis of MRSA infections starts with a medical and physical assessment, like most diseases. Alongside this, numerous types of samples and cultures may be taken from the patient to be analyzed for the MRSA bacteria. These include wound cultures, sputum cultures, urine cultures, and blood cultures. Once a patient is diagnosed with a MRSA infection, they are often isolated to a single room in order to eliminate the possibility of the bacteria spreading. Also, healthcare professionals that treat patients with MRSA often wear Personal Protective Equipment such as gowns, gloves, masks, and eye protection to limit the spread of infection to themselves and others. When this is done, treatment can begin.
Like the symptoms, treatment of MRSA varies according to the type of MRSA infection. The treatment of HA-MRSA usually requires IV antibiotics and depending on the severity of the infection, multiple rounds of antibiotics to be administered. Common antibiotics that are chosen to be administered include vancomycin, daptomycin, linezolid, clindamycin, and trimethoprim-sulfamethoxazole. The type of antibiotic chosen is dependent on the infecting bacterial strain and the severity of the illness. If the attending physician prescribes the best antibiotic for the specific case, the effectiveness of the treatment is high. The treatment of CA-MRSA is slightly different compared to that of HA-MRSA. Treatment of CA-MRSA infections usually begins with the incision and drainage of the infected area. This is sufficient in the treatment of abscesses that are less than 5 cm in diameter. Once this process is completed, the attending physician must decide whether or not antibiotic treatment is required. Antibiotic therapy may not be needed in patients with skin and soft-tissue infections, as incision and drainage of the infection site may be sufficient treatment. Again, if the attending physician assesses the patient and formulates a course of action specifically for that patient, the effectiveness of treatment is high.
MRSA is a highly contagious bacteria. Without effective preventional measures, the spread of MRSA can be devastating. Despite this, there are many practices that can be used to limit the spread of infection. The first line of defense against many, if not all, infections is the proper washing of hands. Scrubbing hands for at least 15 seconds under running water and drying them with a towel is usually sufficient. Keeping wounds covered at all times prevent the bacteria from having easy access to multiply. Do not share personal items and make sure to sanitize all linens. As stated before, the spread of HA-MRSA can be prevented with patient isolation and the use of Personal Protective Equipment by healthcare professionals and anyone who enters the room.
It is imperative to be informed about MRSA because it can cause an infection in the least expected places and at the least expected times. Knowing how to limit the risk factor of contracting MRSA can prevent the possibility of weeks of being hospitalized. Also, being informed can help in informing others how to limit the spread of the bacteria and hopefully limit the need to use copious amounts of antibiotics. If this happens, the possibility of a strain of bacteria worse than MRSA, along with millions of deaths, can hopefully be avoided.
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