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Thursday, January 24, 2008
MRSA, MRSA, MRSA
I was inspired by a patient who came in from the emergency room with three MRSA (methicillin resistant staphylococcus aureus) lesions. He showed me the boil on his stomach. He also had a lesion on his arm and the one that sent him to the ER was the one on his testicle that had burst. I didn't even want to see that one. Poor bastard. I hope the oral/topical antibiotic regimen clears that up for you. Devastating...nobody wants to lose a testicle to a bacteria, and I don't even have testicles to sympathize with so here is a shout out from my ovaries...and a little educational journey for the rest of you.
MRSA was "discovered" about two years after the beta-lactam antibiotic methicillin was introduced as a treatment for staphylococcus. This was way back in 1961. So over the next forty or so years, more of these clever little devils passed on the genetic ability to resist ultimate obliteration by beta-lactam antibiotics. The mechanism is a penicillin-binding protein coded for by a mobile genetic element termed the methicillin resistant gene or mecA. This lovely mechanism is easily spread from gene pool to gene pool and offers pathways to block other antibiotics as well.
For all its media hype, it is only found in 25 to 30% of the world population's nasal passages with less than 1% of that being MRSA (thanks US Centers for Disease Control). This just proves that bad press is the ultimate promotional tool, go Britney and K-Fed!
The Kaiser Foundation reported in 2007 that approximately 1.2 million hospitalized patients have MRSA. This includes a mortality rate of 4 to 10%. The risks of contracting MRSA vary and are more prevalent in clinical settings with a rising infection rate in community settings.
There are only two ways to get infected with MRSA: physical contact with an infected person or carrier and physical contact with something contaminated by an infected person or carrier. Physical contact includes but is not limited to sex, touching body parts, and being sneezed or coughed on. Coughing is especially infective if the patient has MRSA pneumonia. In this case the pathogen is aerosolized in lung secretions and totally reminds me of that movie theater scene in the movie Outbreak where the guy sneezes/coughs and there is that slow motion shot of the ebola infected secretia droplets spreading throughout the room...gross... Other types of physical contact can come from door knobs, sheets, floors, sinks, towels, computer keyboards, etc. Contamination is everywhere......
Don't be scared, it really is not that dangerous. You are feeling the anxiety generated by rabid newsies going for ratings. I don't need ratings, I am not paid for this. It is merely a labor of love and something to fill the void left by the writers' strike.
You must have a break in the skin or inhale infective droplets. Breaks in the skin can include piercings, cuts, scrapes, burns, scaling (like psoriasis), surgical wounds, rubbing your eyes, etc. Other patients who need to watch out are immunocompromised patients, such as patients with cancer, transplants, diabetes, pneumonia, pregnant/breast feeding, on oral/injectable steroid therapy, etc. Health care workers are no exception. Hospitals and nursing homes have the highest prevalence of MRSA along with other types of clinical acquired infections and should take proper precautions to prevent spread of infection from patient to patient.
Signs and symptoms of MRSA infection:
*cellulitis-infection of skin or fat and tissue immediately beneath the skin, usually starts as small red bumps
*boils-pus filled infections of hair follicles
*abscesses-collections of pus in and under the skin
*sty-infection of eyelid gland
*carbuncles-infection larger than an abscess, usually with several openings to the skin
*impetigo-a skin infection with pus filled blisters
Any of these accompanied by fever, chills, low blood pressure (feelings of passing out, dizziness, lightheadedness), joint pain, headache, shortness of breath, or all over body rash should seek medical attention immediately. MRSA can spread to internal organs and lead to complications or death if not treated early.
The FDA approved the BD GeneOhm StaphSR assay that can detect MRSA within 2 hours, where cultures require one to two days for positive results. The clinical trials used for approval showed a 100% detection of MRSA and a 98% detection of other common, less infective staph. There is a caution though because it should not be used as the sole diagnosis and does not rule out other infections.
What this all means for you: KEEP IT CLEAN!
Clean your dorm rooms, locker rooms, classrooms, shower and change sheets after sex, don't touch your friend if they have the infection, wash sports equipment frequently, clean wounds and wash hands. Clean everything and you will probably never get a lesion. Just don't go crazy and end up in a plastic bubble. If it looks like a gigantic pimple but hurts worse than any zit you have ever had or you have other symptoms get it checked out.