Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA is resistant to methicillin and many other antibacterial agents.24 It is spread by direct contact with an infected wound or contaminated bed linens, bed rails, bathroom fixtures, medical equipment, and personal items. About one in three people carry Staphylococcus aureus and two in 100 carry MRSA in their nose or on their skin. Carriers are asymptomatic, but they can also spread the bacteria to others.

Clinical Features

In the general community, MRSA infections usually involve the skin. Signs of infection include redness, warmth, swelling, fluctuance, draining pus, fever, and pain at sites that initially may have looked like a “spider bite.” Infections can also occur at sites covered by body hair or where uniforms or equipment cause skin irritation or increased rubbing. In healthcare settings, MRSA can cause surgical-site and catheter-related infections, bacteremia, and pneumonia.

Prevention

In the general community good personal hygiene practices, i.e., good hand and body hygiene can reduce the risk of MRSA infection. Cuts, scrapes, and wounds should be kept clean and covered until healed. The sharing of personal items (e.g., towels and razors) should be avoided. In healthcare setting MRSA infections can largely, if not completely, be prevented by adherence to Standard Precautions (e.g. hand hygiene and the use of personal protective equipment).

Medical Management

Incision and drainage and obtaining specimens for culture and susceptibility testing are the first step in treating purulent skin infections. Empirical adjunctive antibacterial coverage (modified later based on susceptibility) may be warranted with severe local symptoms, infections in an area difficult to drain, and for immunocompromised patients. Patients who do not respond to incision and drainage and/or develop constitutional symptoms require hospitalization.