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.

Here is a brief MRSA information pack.

What is MRSA?

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes difficult to treat infections. It is a more resistant variation of Staphylococcus aureus (SA).

Where is MRSA Found?

About 30% of people in the UK carry MRSA in their nose or on their skin. It does not become a problem unless it enters the body.

Symptoms of MRSA

In the first instance boils, abscesses, sties, carbuncles and impetigo may develop. Once MRSA enters the blood stream Septicaemia, septic shock, lung infection and infection of the heart lining can occur.

The Spreading of MRSA

MRSA can be spread via the hands (skin-to-skin contact), by sneezing or by touching shared equipment that is also used by someone with MRSA.

Information About Hospital Acquired MRSA

Hospital Acquired MRSA strikes around 100,000 people every year, which is about 44% of all cases. This costs the NHS £1 billion annually. Government statistics point to an increase in hospital MRSA of 60% over the past decade. The Office For National Statistics found that MRSA deaths are around 1,650 (recorded in 2005 and 2006).

The Spreading of Hospital MRSA

Inadequate cleaning and hygiene procedures by hospital staff are the main cause of MRSA in hospitals. This is the means by which MRSA bacteria can transfer from patient to patient. Healthcare workers may pick up the bacteria on their clothes or on their hands. Hospital equipment also may not be adequately cleaned.

Community Acquired MRSA (CA-MRSA)

Carriers of CA-MRSA do not necessarily demonstrate symptoms of MRSA. Strains of Staphylococcus aureus (SA) are unable to colonise their hosts for long periods of time before causing infections. CA-MRSA is relatively harmless and if symptoms do occur it may be in the form of boils or minor infections.

‘Killer’ MRSA

In contrast ‘Killer’ MRSA destroys the immune system. It is a rare mutation of MRSA. Symptoms may include pneumonia, very high temperatures and coughing up blood. If it spreads to the lungs only a quarter of victims survive.

Vancomycin-resistant Staphylococcus aureus (VRSA)

VRSA is a rare strain of MRSA that is resistant to Vancomycin. Vancomycin is the drug of last resort and is used when all other drugs have failed to treat MRSA.

Efforts To Combat MRSA

The Labour government have launched a programme that will see hospitals ‘deep cleaned’. However, we have been taking measures to combat MRSA for some time.

In the 1990’s, the NHS was isolating all patients with MRSA and screening all staff. If staff were carrying MRSA, then they would be removed from work until they had undergone eradication therapy.

Since 2004, the ‘clean your hands’ campaign has led to alcohol-based hand rubs being placed at the entrance to wards and near all beds. Staff and visitors are encouraged to wash their hands regularly.

The number of cleaners in the NHS fell from 100,000 in 1984 to 55,000 in 2004. This trend must be reversed if the battle with MRSA is to be won. Furthermore, the contractual arrangements made with the private sector responsible for cleaning hospitals should be reassessed.

The reintroduction of matrons, continuous MRSA education programmes directed at hospital staff and new powers given to hospital nurses to ensure that visitors wash their hands regularly are crucial if we are to be successful in combating MRSA.