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Resistant Staph Aureus (MRSA)

Methicillin resistant staphlococcus aureus (MRSA) is a potentially life-threatening bacterial infection whose incidence is rapidly increasing. The most common route of transmission for this infection is skin to skin contact between unsuspecting individuals. If not treated aggressively, MRSA can quickly cause large amounts of skin to be lost due to gangrene, eventually leading to sepsis and death.

As with all infections, keeping your immune system healthy and avoiding contact with infected individuals are the two most effective ways to prevent being affected by this infection. The following paper contains common-sense information to help treat and prevent MRSA.

  • Introduction

    Since initially reported in 1981, methicillin-resistant Staphylococcus aureas (MRSA) has become one of the most frequently diagnosed skin infections in the United States.1 Most cases of MRSA originate in the hospital setting, where risk factors include a history of hospitalization, surgery, long-term residence, and colonization with resistant staphylococcus bacteria. Cases contracted outside of the hospital, referred to as community acquired-MRSA or CA-MRSA, have become one of the more virulent bacterial infections in the US, especially present in densely populated cities such as San Francisco, Baltimore and Atlanta.2

  • Lifestyle Factors

    The Hospital Setting:

    Within the hospital setting, MRSA has been a significant concern since the 1960's. 3 Since that time, approximately 20% of sepsis cases (bloodstream infections) have been caused by S. aureas.4This infection has been on the rise because of overcrowding, understaffing, poor hand washing compliance, and overloaded screening and isolation facilities.5These conditions decrease the effectiveness of antibiotics because, as multiple infections occur in the same individuals, resistance to antibiotics is facilitated 6.

    So, what are some practical and effective hygiene measures that can be utilized in the hospital setting? Proper cleaning procedures in the intensive care unit (ICU) can have a significant impact on the presence of MRSA. Interventions such as educational campaigns, discussions on cleaning policies, and the use of bucket immersion for applying disinfectant can reduce the likelihood of culture positive MRSA from 45% to 27% during the intervention.7 According to guidelines provided by the Centers for Disease Control (CDC), washing your hands after coming into contact with any fluids, appropriate gloving, mouth, eye and nose protection, gowning, and soiled laundry handling all must be diligently maintained.8

    The Community Setting:

    How does the spread of MRSA occur in the community setting? According to the Journal of Annals of Internal Medicine, the highest concentration of MRSA is located amongst gay men in San Francisco's Castro district, where the lack of appropriate hygiene increases the risk of exposure. The most frequent location of the infection is around the genitalia and buttocks (40%), where it is skin-to-skin contact through sexual activity that greatly facilitate the spreading of the infection.9 However, any part of the body can develop a MRSA infection.

    In other urban areas such as Baltimore, Atlanta, and Davidson County (TN), the highest incidence is among blacks, where low socio-economic status and inferior hygiene practices is suspected to increase the risk of transmission.10 Although these communities have a higher incidence, MRSA has been found also among athletes, military recruits, children, prison inmates, and within other cultures as well.11Again, the common thread between these groups appears to be close contact with infected individuals where appropriate hygiene measures are not being utilized.

    In all cases of MRSA, following the CDC guidelines can help curtail the contraction of this illness:

    1. Keep hands clean by washing thoroughly with soap and water, or using an alcohol- based hand sanitizer

    2. Keep cuts and scrapes clean and covered until completely healed

    3. Avoid contact with other people's wounds

    4. Avoid sharing personal items such as towels and razors.12

  • Standard Medical Therapies

    When To Seek Medical Advice

    Keep a close eye on minor skin problems (i.e. pimples, insect bites, cuts and scrapes) especially in children. If wounds become infected, see your doctor.

    Signs and symptoms of a wound infection include:

    • Redness, warmth, and tenderness of the wound
    • Pus - a yellowish-white fluid that may have a foul smell
    • Fever

    Ask to have any skin infection tested for MRSA before starting antibiotic therapy. Some drugs that treat ordinary staph aren't effective against MRSA, and their use could lead to more resistant bacteria and serious illness.

    Drug Treatments

    Both hospital and community-acquired strains of MRSA still respond to certain medications. In hospitals, doctors often rely on the intravenous antibiotic vancomycin to treat resistant bacteria. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains. Although vancomycin saves lives, it may become less effective over time. Some hospitals are already seeing strains of MRSA that are less easily killed by vancomycin. In some cases, antibiotics may not be necessary. For example, doctors may drain a simple abscess caused by MRSA rather than treat the infection with drugs.

  • Beneficial Nutrients

    Following the hygiene measures discussed above is the most effective way to prevent exposure to MRSA and thereby avoid contracting this potentially fatal disease. If you don't physically touch something or someone who is colonized or infected with this organism, then it is impossible to become infected with it yourself.

    However, since many people who are colonized with the MRSA don't even know they are carrying this organism, it is hard to completely avoid exposure. For instance, many relatively healthy individuals colonized with MRSA carry the bacteria in their nostrils, but do not exhibit any symptoms of the disease. Even non-intimate contact with these individuals through hugging, sharing a towel, and shaking hands can expose an unsuspecting person to the MRSA bacteria.

    There are three factors that determine the risk of infection from an encounter with any infectious organism:

    • The size of the exposure (the number of organisms a person is exposed to)
    • The virulence of the organism (the inherent strength of the organism)
    • The strength of the affected individual's immune system

    A person with a weak or compromised immune system, exposed to a small dose of MRSA, may come down with a life-threatening infection. A person with a strong immune system, exposed to the same dose of organisms, might not get sick at all.

    Aside from reducing the risk of exposure to MRSA organisms, it would be beneficial to take common sense measures to strengthen the immune system to prevent MRSA from occurring in the first place or recurring.

    The following immune-boosting measures make the most sense for individuals trying to reduce their risk of becoming infected with MRSA:

    • Shower daily with hot water and a soap with antibacterial properties (Lever 2000, Dial, etc). Use a wash cloth or sponge to cleanse the skin and wash it out thoroughly after each use.
    • Take an immune-boosting nutritional supplement that includes significant dosages of vitamin C, alpha lipoic acid, n-acetyl-cyteine, zinc, and selenium. K-PAX Immune Support Formula contains all of the above and has been shown in a published clinical trial to significantly increase the level of key immune system markers.
    • Eat a diet that includes plenty of fresh fruits, vegetables, whole grains, and protein. Avoid highly processed foods containing large amounts of sugar and fats.
    • Exercise at least three times per week.
    • Keep your stress as low as possible. While we cannot always control external events, try to develop a daily practice of stretching, deep breathing, quiet time, and/or prayer to help stay balanced and calm.

    Finally, if you have had MRSA in the past, or if you have been told by a medical professional that you carry the organism in your nose, regularly cleansing the opening of the nostrils and area around the nose with rubbing alcohol is a simple, common sense, and inexpensive way to keep the bacterial count to a minimum.

    In preventing any infection, keeping your immune system well supported through appropriate hygiene, good nutrition, vitamin supplementation, and other methods can strengthen the barrier between you and bacterial infections such as MRSA. Most importantly, if you think you have been exposed to MRSA, discuss the situation with your physician as soon as possible.

  • References
    1. Methiciliin-resistant S. aureaus infections among patients in the emergency department. N Engl J Med. 2006:355(7):666-674. Moran GJ, Krishnadasan A., Gorwitz RJ, et al.
    2. Invasive Methicillin-Resistant Staphylococcus aureus Infections In the United States. JAMA.2007:298(15):1763-1771. Klevens RM., et al.
    3. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: micro-biology, epidemiology. and preventaive measure. Infect Conrol Hosp Epidemiol. 1992:13(12):725-737. Boyce JM.
    4. Nosocomial bloodstream infections in US hospitals, analysis of 24, 179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2006:42(3):389-391. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB.
    5. Overcrowding and understaffing in modern health-care systems: key determinants in methicillin-resistant Staphylococcus aureus transmission. Lancet Infect Dis.2008 Jul:8(7):427-34. Clements A, Halton K, et al.
    6. Ibid
    7. Impact of an environmental cleaning intervention on the presence of methicillin-resitant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol.2008 Jul:29(7):593-9.  Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS.
    8. Centers for Disease Control and Prevention.  Information about MRSA for Healthcare Personnel. 2007 Oct: http://cdc.gov/ncidod/dhqp/ar_mrsa_halthcareFS.html
    9. Emergence of Multidrug-Resistant, Community-Associated, Methicillin-Resistant Staphylococcus aureus Clone USA300 in Men Who Have Sex with Men.  2008 Jan. (Epub ahead of print)
    10. Invasive Methicillin-Resistant Staphylococcus aureus Infections In the United States. JAMA.2007:298(15):1763-1771. Klevens RM., et al.
    11. Ibid.
    12. Centers for Disease Control and Prevention.  Information about MRSA for Healthcare Personnel. 2007 Oct: http://cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html