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Doctors, nurses & patients have been asking us various questions via
email. We are listing them here to help you understand more about
the impending problem we all are soon going to encounter. Please
feel free to ask us any question and also critisise us if we are
wrong.
As doctors,
we
try not to talk about this and usually shy away from the problem
because we know this is not a simple problem and our knowledge but
this bacteria is limited to eradicate this threat.
Table
of Contents
- What is the incubation period for MRSA?
- Which is more likely, did he get MRSA
in the hospital or the nursing home?
- Would MRSA possabely cause pneumonia or
visa versa?
- What is Staphylococcus Aureus?
- Who gets MRSA Infection?
- Can MRSA Infection be prevented?
Incubation period starts once you meet another person infected
with MRSA and you developing the infection. If the bug stays
dormant in the nose without producing any symptoms then you become
a carrier and will continue to pass this on to others.
MRSA
is a bacteria present every where, used to be called MSSA
(bacteria was killed by antibiotics). Skin infections can occur
soon after you come in physical contact (hand to wounds, body to
body or as in USA300 abscess in buttocks.
Major problem with this bugs occur when they enter blood stream,
lungs or brain. They produce symptoms in hours and can kill in
12-24 hours.
This
bacteria is said to kill all the white cells in your blood in 5
minutes (entire army of defence is wiped out), they can produce
shock, DIC, bleeding or digest muscles (flesh eating) and lung
(necrotising pneumonia)
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Difficult to answer because infection can occur at home, nursing
home or in hospitals. Infection in hospital was caused by HA-MRSA
and from the community strain CA-MRSA. Now it is said to become
difficult to differentiate these two strains.
If
your immune system is weak like patients on treatment for cancer,
on large dose of steroids or immuno suppression (transplant
surgery, arthritis patients), infection spreads rapidly
"This bug not only has a bullet proof vest, but in terms of its
virulence, it now has an exorcet missile attached as well"
Professor Collignon says of the 'PVL' toxin attached to CA-MRSA.
"I think we need to be scared" he concluded.
We
are sure people who contract MRSA in a hospital, presumably think
this antibiotic resistant organism live only in hospitals.
Yes,
MRSA can enter blood and is trapped in lungs or this can spread
through mucus membrane of nose to wind pipe and enter lungs. MRSA
meningitis reported in Italy, patient had MRSA in spinal fluid but
the patient died with lung
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Staphylococcus aureus is a bacterium (germ). It is often just
called 'S.aureus' or 'staph'. S. aureus bacteria are often found
on the skin and in the nose of healthy people. In fact, about 3 in
10 people have S. aureus bacteria living on (colonizing) their
skin. These people are called S. aureus 'carriers'. In healthy
people who are
carriers, S. aureus is usually harmless. However, S. aureus
bacteria sometimes invade the skin to cause infection. This is
more likely if you have a cut or graze which can allow bacteria to
get under the surface of the skin. S. aureus is the cause of skin
infections such as boils, pimples, impetigo, skin abscesses, and
is a common cause of wound infections.
In
some people, S. aureus can sometimes get into the bloodstream and
travel to internal parts of the body to cause more serious
infections. For example, blood poisoning (septicaemia), lung
infection (pneumonia), bone infection (osteomyelitis), heart valve
infection (endocarditis), etc. These serious infections are more
likely to occur in people who are already unwell or debilitated,
or who have a poor immune system. These infections need to be
treated with antibiotics.
MRSA occurs most commonly in people who are already in
hospital. People who are more prone to it are those who are very
ill, or have wounds or open sores such as bed-sores or burns. The
wounds or sores may become infected with MRSA and the infection is
then difficult to treat. Infections which start in the skin may
spread to cause more serious infections. Also, urinary catheters
and tubes going into veins or parts of the body ('drips' etc) are
sometimes contaminated by MRSA and can lead to urine or blood
infection. MRSA can also cause infections in people outside
hospital, but much less commonly than in hospitalized people.
The
number of MRSA infections in hospital can be kept down if all
hospital staff adhere to good hygiene measures. The most important
is to wash hands before and after contact with each patient, and
before doing any any procedure. This simple measure reduces the
chance of passing on bacteria from patient to patient.
Other measures are used in hospitals to reduce the spread of
infection. For example, cleaning of bedding, regular cleaning of
wards, etc. Patients with an MRSA infection may be kept away from
other patients, perhaps in a single bed room or in an isolation
unit until the infection has cleared.
What is MRSA?
MRSA
stands for methicillin-resistant Staphylococcus aureus. There are
various subtypes (strains) of S. aureus and some strains are
classed as MRSA. MRSA strains are very similar to any other strain
of S.aureus. That is, some healthy people are carriers, and some
people develop the types of infections described above.
The
difference is that, most S. aureus infections can be treated with
commonly used antibiotics. In recent years some strains of S.
aureus have become resistant to some antibiotics. 'Resistance'
means that it is not killed by the antibiotic. MRSA strains are
not only resistant to the antibiotic called methicillin, but also
to many other types of antibiotics.
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How serious is an MRSA
infection?
MRSA
strains of bacteria are no more aggressive or infectious than
other strains of S. aureus. However, infections are much more
difficult to treat because many antibiotics do not work.
Therefore, infections tend to become more severe than they may
otherwise have been if the cause of the infection is not diagnosed
early, and antibiotics that do not work are given at first.
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How common is MRSA?
As
mentioned, being a carrier of S. aureus and infections with S.
aureus are very common. The number of cases due to MRSA strains is
not known, but it is becoming a more common problem.
How
is MRSA diagnosed? If an infection with S. aureus is suspected
then, depending on the type of infection, a
sample of blood, urine, body fluid, or a swab of a wound can be
sent to the 'lab' for testing. If S.aureus is detected, further
tests are done to see which antibiotics will kill the bacteria.
MRSA strains can be identified by seeing which antibiotics kill
the bacteria found on testing. Healthy people suspected of being
carriers of MRSA can have a swab or the nose or skin taken and
tested.
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How is S.aureus and MRSA spread?
S.aureus bacteria (including MRSA strains) spread from person to
person usually by direct skin-to-skin contact. Spread may also
occur by touching sheets, towels, clothes, dressings, etc, which
have been used by someone who has MRSA. However, as mentioned, S.
aureus (including MRSA strains) will not normally cause infection
if you are well. The bacteria may get onto your skin, but do no
harm. So, for example, people who visit patients with MRSA, or
doctors and nurses who treat people with MRSA, are not likely to
develop an MRSA infection. But, they may become 'contaminated'
with the bacteria and may pass it on to someone who is ill, or
who
has a wound, who then may develop infection.
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What is the treatment of MRSA
infections?
MRSA
infections are usually treated with antibiotics. (Boils or
abscesses caused by MRSA may only need to be drained and may not
need antibiotics.) However, the choice of antibiotic is limited as
most antibiotics will not work. Many MRSA infections can only be
treated with antibiotics that need to be given directly into a
vein. The course of treatment is often for several weeks. Also,
the risk of side-effects with the limited choice of antibiotics is
higher than the more 'usual' antibiotics which are used to treat
non-MRSA infections.
People who are carriers of MRSA but who are healthy do not need
any treatment. However, in some cases it may be advised to try and
clear the bacteria from the skin by washing with antiseptic
lotions, and using antiseptic shampoos, and using an antibiotic
cream to place in the nose. These measures may reduce the risk of
developing an infection, or spreading the bacterium to others
(particularly to ill people who may develop an infection).
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