Emerging Threats: Community Aquired Methicillin Resistant Staph Aureus (MRSA)

Write this down---Methicillin Resistant Staph Aureus (or MRSA, for short- sometimes pronounced MerSa). If this is the first time you’ve heard of it, I can assure you it won’t be the last. I predict that within a decade you or a loved one will likely have a personal encounter with this Super Bug. Does the sound of this bother you? It should, read on.

What is MRSA?
MRSA is a nasty bacteria on the loose. Originally confined to the hospital setting, a community acquired form of Methicillin Resistant Staph Aureus (CA-MRSA), a potentially dangerous bacteria, is cropping up in multiple settings.

(Note: In the news, you may see the name MRSA and CA-MRSA interchanged. As a rule, MRSA is divided into two camps- that caught in hospitals, and that in the community. For purposes of this webpage, when I write MRSA, I refer to the less invasive, community aquired form).

From nursing homes to NFL locker rooms, MRSA is emerging as a public health threat. This bacteria, a nasty strain of Staphylococcus, derives it’s name from the fact that it is resistant to Methicillin and other drugs that normally kill it. While MRSA has been around for a number of years, as of lately it has evolved into a more “virulent” mutant. The main reason for this bug’s toughness; the over-prescription of antibiotics.

Why is MRSA so tough?
When you take an antibiotic, whether for an appropriate reason (example: pneumonia) or an inappropriate use (a viral illness, such as a “cold”), you run the risk of developing a drug resistant bacteria. For those “Creationists” who shun the teachings of Darwin (and the subsequent decades of scientific research that support his theory of evolution), if you catch a super bug- you are living proof that evolution exists. Genes mutate, bacteria flourish. The more we bathe these bacteria in antibiotics, the more likely they adapt and grow stronger. It’s natural selection taking place right in your bowels, on your skin, up your nose. The antibiotic pressure on these organisms in our communities is intense. Doctors over prescribe these medications to patients demanding "strong medicine" to cure their runny noses, coughs and aches. In the war between bugs and drugs, the bugs are winning.

How is MRSA caught?
A person may catch MRSA by direct contact with an infected individual. Many people (up to 30% of the population) are colonized with staph bacteria, with a growing number the superbug MRSA. It could come from close contact with a love one or jabbing elbows with a team mate under the hoops. The national football league has reportedly had trouble with CA-MRSA; as have wrestling leagues, fencing clubs and others. I’ve had nursing home staff catch it from either a contagious patient or contaminated equipment. As above, some people are colonized with MRSA and have no symptoms, but may still spread it around. In short, MRSA appears to be an ubiquitous organism that is prevalent in the community. It's out there folks.

How does is make you sick?
If there is one good thing to say about MRSA is that, compared to it’s hospital variant, it is far less deadly. There have been some sporadic deaths from MRSA (the occasional liver, brain or lung infection), but for the most part, the community aquired form of MRSA confines it’s damage to the skin; namely in the form of skin boils.

How does MRSA present?
Many patients present thinking they have a “spider bite.” For instance, a prison reported a massive surge in inmates showing up with "spider bites." Further investigation proved otherwise- another win for this super bug. Many inmates were colonized with MRSA, and a growing number came down with skin infections.

In my practice I see the same presentation of MRSA- "I have this spider bite, Doc!" These patients have one thing in common, when pressed, none can actually recall being bitten. The “bites” all look about the same- a red coin sided boil with a darker, central black spot. Some lesions, by the time they reach me, have already started draining pus.

How are MRSA boils treated?
If the boil is ready to break open, then it should be incised and drained by a doctor. DO NOT ATTEMPT TO POP IT YOURSELF! This may cause the boil to break “inwardly” and spread the infection locally, or worse. Incision and drainage is often curative. If antibiotics are needed, usually for multiple lesions or severe localized infection with or without fever, they will be prescribed. Fortunately, many strains of CA-MRSA (while resistant to many antibiotics) will still respond favorably (for now) to a select few oral drugs such as sulfa, erythromycin, or clindamicin. I should emphasize the need to drain these boils. All the antibiotics in the world will not get into the center of a walled off boil. Incision and drainage is usually needed.

Can MRSA be cured?
With treatment, most localized MRSA skin infections will go away. However, a certain number of these infections may be recurrent- usually with more of the same; boils, boils, boils! About 30% of the general population is colonized with staph organisms and a growing number of those colonized have MRSA. Staph often “hangs out” in the nose- not causing problems. After localized treatment, some recommend trying to "eradicate" the organism. There are a variety of attempts to do this. Some doctors will try antibiotic pills for a few weeks. Since MRSA often in colonized in the nose, some suggest usuing Bactroban ointment in the nostrils twice a day for a week or so. Others have tried Hibiclens, an antiseptic lotion, as both a shampoo and body wash. However, these methods appear to be doomed to failure. Once colonized with MRSA, many people may remain so for years. This is a tough bug to get rid of.

Will taking antibiotics give me MRSA?
Broad spectrum antibiotics, such as the ubiquitous Z pac, are heavily prescribed, drugs. While taking one of these antibiotics will not directly give you a resistant bug, bathing an entire community in these drugs will increase the risk that one of these germs will mutate and become resistant. Then, this resistant bacteria can spread from contact to contact, and eventually to you. Conceivably, you could never take an antibiotic (ever!) and still become infected with a drug resistant organism. In the war of drugs against bugs, we are losing.

How can I prevent getting infected with MRSA?
Besides living in a space suit, there are some simple things you can do to help prevent the spread of MRSA and other nasty bugs. First and foremost, wash yourself. If you work or live around people (in other words, if you are not stranded on a desert island) then you are at risk for catching one of these bugs. Hand washing frequently, don’t pick your nose and don’t cough on people- Pretty much what you learned in first grade. In addition, when you go to the doctor for sinus pressure, a sore throat and a cough, chances are you do not need an antibiotic. Antibiotics don't kill viures. If have a cold, Please don’t ask for antibiotics. Your doctor can prescribe strong decongestants and cough syrups to help. Do you part to help win the War On Bugs.

LINKS
The website, Aware, has great information on how to prevent antibiotic mis-use.
The Centers for Disease Control also has great info; CDC-MRSA