Defining Community-Acquired MRSA
A community-acquired MRSA infection is an MRSA infection in an individual who has had:
- MRSA identified within 48 hours of admission to a hospital
- No history of hospitalisation, surgery, dialysis, or residence in a long-term care facility within 1 year of the MRSA culture date
- No permanent indwelling catheter or medical device
- No known prior positive culture for MRSA.
It should be noted that in practice it is difficult to separate true community-acquired MRSA from MRSA that people out in the community may have acquired from a healthcare setting, or from close contact with a person in a healthcare setting.
Community-Acquired MRSA – The Basics
MRSA infections are usually associated with hospitalisation or other healthcare-associated risk factors. More recently however, physicians and other healthcare providers have observed an increasing number of people with MRSA infections who seem to lack traditional healthcare-associated risk factors. It appears that these people have community-associated infections. Skin and soft tissue infections such as abscesses or cellulites are the most common kind of infection caused by Staphylococcus aureus.
The incidence of community acquired MRSA infections is greater amongst younger and healthier people compared with healthcare-associated MRSA. CA-MRSA bacteria is generally less problematic than healthcare-associated MRSA and is usually susceptible to more types of antibiotics.
Identifying Community-Acquired MRSA
CA-MRSA most often appears as a skin or soft-tissue infection. This could be a boil, pimple, or abscess, in an otherwise healthy person. The area in question often becomes red and swollen. It maybe painful and have pus or a discharge. A person should pay particular attention to any cuts and scrapes and hairy areas of the body, such as the back of the neck, groin, buttocks, armpits, and the inner thigh.
Although community-acquired MRSA is relatively harmless in some cases it has been associated with more serious conditions. CA-MRSA has been associated with necrotizing pneumonia and empyema; sepsis syndrome; musculoskeletal infections, such as pyomyositis and osteomyelitis; necrotizing fasciitis; purpura fulminans; and disseminated infection with septic emboli.
At its extreme community-acquired MRSA has resulted in death. Ten years ago four children in Minnesota and North Dakota were reported to have died from CA-MRSA infections. It should be stressed however; in the vast majority of cases CA-MRSA does not cause life-threatening conditions and can usually be dealt with speedily and effectively. Measures should be taken to prevent the spreading of CA-MRSA and therefore we must understand how it is passed from one individual to another.
The Spreading of Community-Acquired MRSA
CA-MRSA infections can be spread by contact with infected skin or personal items that have been in contact with infected skin such as towels, bandages, or razors. The bacteria get into the skin through cuts. Bacteria are more likely to spread where there is close contact between people. Outbreaks have been reported in football, wrestling, rugby, soccer, fencing, canoeing, prison inmates, and the military. There have also been CA-MRSA cases in tattoo recipients.
Community-Acquired MRSA: In Summary
A clear distinction is made between CA-MRSA and healthcare-associated MRSA. However, ensuring that CA-MRSA patients really do not have any link to a healthcare setting is often quite difficult.
CA-MRSA tends to affect a different section of the population – younger and healthier people compared to hospital MRSA. In most cases, CA-MRSA is also easier to treat.
Care should be taken in environments where there is close contact between people to prevent the spread of CA-MRSA. It should be stressed however, it is very rare for CA-MRSA to result in a serious or life threatening health condition.