CONDITIONS

What Is MRSA and Staph

Staph is a type of bacteria that can cause infections almost anywhere in the body. Staph infections are caused by the Staphylococcus bacteria, which live on our skin and in our mucosal membranes (like inside our nose). Most of the time, staph does not cause any issues—but if it enters a break in the skin, like a bug bite, pimple, scratch, or cut, the bacteria may cause an infection. Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of staph bacteria that’s become resistant to the antibiotics commonly used to treat ordinary staph infections. Both staph and MRSA infection may commence as a minor skin sore, pimple, or painful boil—and while most staph and MRSA infections are minor, they can become serious, potentially dangerous and sometimes be fatal.

MRSA and staph infections were once most commonly seen in hospital or health care centers, like nursing home settings; healthcare workers and patients in these facilities are both affected. When the infection is MRSA, it is known as “Healthcare Associated MRSA”or HA-MRSA.  HA-MRSA infections typically are associated with invasive procedures or devices, such as surgeries, intravenous tubing or artificial joints.

More recently, however, people who have not been associated with hospitals or healthcare centers have been increasingly diagnosed with both staph and MRSA infections. When the infection is MRSA, it is known as “Community Associated MRSA” or CA-MRSA. It’s important to point out that in today’s world anyone is susceptible to MRSA—and both staph and MRSA can be highly contagious from person to person.

There are two main ways to get staph or MRSA: first is through direct contact with someone who is already infected with either infection. The second is by touching materials or surfaces that are contaminated by staph or MRSA. This could be from sharing razors, sports equipment, towels or even clothes.

This is the likely reason that we see staph and MRSA outbreaks in schools, dorms, and within sports teams. Make sure to take extra care when touching a doorknob or other public objects if you have an open cut or sore.  Because MRSA typically responds to very few—if any—antibiotics, and can be very difficult to treat, it is often referred to as a “superbug”. Many public health experts are alarmed by the spread of tough strains of MRSA.

MRSA, also known as Methicillin-resistant Staphylococcus aureus, was discovered in 1961, and the first case of MRSA in the United States was confirmed in 1968. A new study has suggested that a type of MRSA found in humans may have originated from cattle as far back as 40 years or more.

According to the CDC, or Center of Disease Control:

  • One in every three—or 30%–of people carry the staphylococcus bacteria in their nose
  • One in one hundred—or 1%–carry MRSA

In the 1940’s, Penicillin became the first antibiotic to successfully treat staph infections. However, due to overuse and misuse of penicillin the bacteria became resistant. This means the bacteria “outsmarted” the antibiotic. A new treatment was then discovered call methicillin. However, not even after 10 years after it began to be used, the staph bacteria once again became resistant to the antibiotic. In 1961 the first Methicillin resistant staph infection (MRSA) was discovered.

Resistant bacteria strains can be very dangerous and can cause many problems for the future in healthcare. Can you imagine a world where antibiotics no longer work?

 

What Causes MRSA and Staph

Different varieties of staph bacteria are normally found on the skin or in the nose of about one-third of the population. The bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they usually cause only minor skin problems in healthy people.


Antibiotic resistance

MRSA is the result of decades of often-unnecessary antibiotic use. For years, antibiotics have been prescribed for colds, flu and other viral infections that don’t respond to these drugs. Even when antibiotics are used appropriately, they contribute to the rise of drug-resistant bacteria because they don’t destroy every germ they target. Bacteria live on an evolutionary fast track, so germs that survive treatment with one antibiotic soon learn to resist others.

But staph can be a problem if it manages to get into the body, often through a cut. Once there, it can cause an infection. Staph is one of the most common causes of skin infections in the U.S. Usually, these are minor and don’t need special treatment. Less often, staph can cause serious problems like infected wounds or pneumonia.

Staph can usually be treated with antibiotics. But over the decades, some strains of staph — like MRSA — have become resistant to antibiotics that once destroyed it. MRSA was first discovered in 1961. It’s now resistant to methicillin, amoxicillin, penicillin, oxacillin, and many other common antibiotics.

While some antibiotics still work, MRSA is constantly adapting. Researchers developing new antibiotics are having a tough time keeping up.

Staph can typically be treated with antibiotics, but in the decades since antibiotics have been in use, some strains, like MRSA have become resistant to treatment. MRSA is the result of antibiotic over use, as they are often prescribed unnecessarily, which has led to antibiotic resistance. MRSA is now resistant to:

  • Methicillin
  • Penicillin
  • Amoxicillin
  • Oxacillin, among others

There are still a few antibiotics that work to treat MRSA, but this potentially dangerous bacteria is adapting quickly, which means that the few treatments left may not work for much longer. Researchers are having a difficult time creating new antibiotics, and have called MRSA a potential health crisis in the making.


Consequences of antibiotic resistance and inappropriate use of antibiotics include:

  • Increased levels of disease and death
  • Increased duration patients have to stay in hospital
  • Increase in patients becoming colonized or infected with resistant bacteria
  • Difficulty in treating infections as bacterial resistance grows

Inappropriate use of antibiotics is thought to have initiated the development of resistance. Inappropriate use and prescribing includes:

  • Failing to complete a course of antibiotics as prescribed
  • Doses of antibiotics being skipped
  • Failure to take antibiotics at regular intervals
  • Saving antibiotics for use as at a later date
  • Unnecessary prescription of antibiotics
  • Improper use of broad-spectrum antibiotics
  • Inappropriate selection and dose duration of antibiotics

In a vast population of bacteria, there may be some that are unaffected by the antibiotic, which survive and reproduce, producing more bacteria that are not affected by the antibiotic. These stages in development of bacteria resistance can include:

  • Changes or mutations occurring in the genes of individual bacterial cells
  • Mutations protecting the bacterial cells from the effects of the antibiotic
  • Bacteria devoid of mutations die and cannot reproduce due to the antibiotic
  • Bacteria with mutations—the resistant bacteria—can reproduce with less rivalry from normal bacterial strains

Risk Factors For MRSA and Staph

Anyone can be at risk for getting  staph or MRSA infection, but some people have a higher chance depending on where they live, or the types of disease they already have.  So who is most at risk? HA-MRSA and CA-MRSA generally occur in different settings; therefore the risk factors for each tend to differ from one another.

Healthcare Associated MRSA (HA-MRSA): Working in a hospital or having frequent hospitalizations will make you at higher risk for getting MRSA. Also if you have any foreign devices in your body such as, urinary catheters or permanent IV lines. People who work or reside in nursing home facilities or who go to dialysis centers, also have a higher chance of getting infected. People who have a weakened immune system such as HIV/AIDS or cancer also can easily get MRSA from contact.

Community Associated MRSA (CA-MRSA): Skin-to-skin contact is the number one way to transmit MRSA between people. Athletes, especially those that participate in contact sports, are at a higher risk for developing CA-MRSA because they tend to share equipment, towels, bath soaps and more. In general, children have a higher chance of getting infected with MRSA– this is especially the case with children who attend an after-school childcare or who play sports.  Risk is also higher among groups that live in close quarters, such as military personnel, prison inmates, and college kids in dorms. As well, homosexual men have a higher risk of contracting MRSA.

Animal Contact: It is unclear if MRSA or Staph bacteria can be transferred from animals but the bacteria has been found in dogs, cats, rabbits, cows, pigs and more.

MRSA bacteria have the ability to survive for extensive periods of time on surfaces and objects like: door handles, floors, sinks, taps, cleaning equipment, and fabric—which can be especially challenging in a healthcare setting.

The good news is that according to the CDC, invasive HA-MRSA infections declined 8% between 2011 and 2013.

 

Diagnosing MRSA and Staph

Diagnosis of staph or MRSA infection is done by taking a culture, which is then sent to a lab. Since this can take up to several days, however, if your doctor is suspicious that you may have a staph or MRSA infection, he or she will likely go ahead and start treatment before the results are back. When you go to see your physician, they will start with asking questions about your medical history, family history and about your current symptoms. Then they will do a physical exam. Usually cultures can be done in the office by collecting some of the pus or making a small cut in the wound and collecting any drainage, which will then be sent to the lab. Newer tests that can detect staph DNA in a matter of hours are now becoming more widely available, which can speed and aid treatment. If the wound is really large, sometimes patients need surgery to drain out the infection. If you are having symptoms of a more serious infection, sepsis, or joint infection, your doctor will likely send samples of your blood to the lab as well.

Once the cultures are positive for staph, the lab will test the bug to see if it is resistant to certain antibiotics, which will then let the doctor know if you have MRSA. This is very important in guiding the doctor to which antibiotic will work best for your infection.

 

Symptoms of MRSA and Staph

Most staph and MRSA infections start off as a small cut or bug bite on the skin that progressively gets worse. Once the staph infection starts to spread, you will start to notice the area around the infected site get red, warm, swollen, and become painful to the touch.
The symptoms of staph and MRSA depend on where you’re infected. Most often, the infection is mild, and presents on the skin like a sores or boil, with a pocket of pus.  Often these infections are found in moist areas like under the arms, groin, buttocks, or in the beard area on a man.  But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.


Staph and MRSA infections often are:

  • Red
  • Inflamed
  • Warm or hot to touch
  • Full of pus or liquid
  • Accompanied by low-grade fever

A more progressive form of staph is cellulitis. Cellulitis develops when the infection spreads deeper in the skin. Cellulitis appears as larger red, warm areas of skin that can even ooze. This commonly will appear on the lower legs.


Two types of skin infections with staph that are common in children are:

  • Impetigo. With impetigo, you will notice a round, red rash with honey-colored crusted borders. It is very important to know that this is very contagious. If you think you or your child may have impetigo, it is best to get it treated right away.
  • Scalded skin syndrome. Scalded skin syndrome can appear as a rash that peels, or blisters away. This is more common in infants and young children.

In more serious cases of staph and MRSA, the infection can spread to the blood stream, which is otherwise known as sepsis, or even the joints. When this occurs your symptoms become more severe. If you have any of the following you should see your doctor right away:

  • Fever of 100.4 degrees Fahrenheit and over
  • Night sweats
  • Swelling and pain of the affected area
  • Muscle aches and pain
  • Joint pain
  • Chills
  • Headache
  • Malaise and confusion
  • Skin infections that do not start improving after 3-4 days

 

Prognosis

The outcome of staph and MRSA infections depend mainly on how severe the infection is. Most infections will resolve on their own in a few days or with antibiotics in a week or two. If the infection spreads to the blood or joints and you need IV antibiotics or possibly hospitalization, it could take weeks to recover. If MRSA becomes sepsis or pneumonia, the outcome is very poor, with a death rate of about 20%.

Living With MRSA and Staph

If you are diagnosed with a staph or MRSA infection, you can continue your daily regular routine and activities if you feel well. Make sure to carefully wash your hands often, and to clean all surface areas that come in contact with the infected site.

Prevention

To help prevent the spread of staph or MRSA infections it is important to:

  • Wash your hands. This is by far the best way to prevent the spread of staph and MRSA. A simple hand sanitizer won’t do the trick. Soap and warm water is all you need—scrub with soap ideally for at least 20 seconds and rinse for nearly as long. Wash your hands before and after playing sports, using shared sports equipment (like machines at the gym), and changing a band-aid or bandage on a cut or wound.
  • Shower. Take a shower immediately after exercising—and make sure to not share items that touch your bare skin, like razors, towels, bar soap.
  • Use a barrier. A barrier can mean a few different things in this context:
    • Cover cuts and scrapes with a bandage to keep germs out will significantly lower the risk of infection. And if you do have staph of MRSA, will keep others protected.
    • Use a towel as a barrier between your skin and publicly used areas like benches in locker rooms, saunas, and steam rooms; or exercise mats at the gym.
  • Wash your sports clothes or uniform. Washing your athletic clothes after each usage, and taking care to dry completely in a dryer, kills lurking bacteria and can help keep you infection free.

If your child has a staph infection or MRSA they do not need to stay home from school, unless advised to by their doctor. It is best to notify the school nurse and teacher so they can take extra precautions in keep the area and equipment, if used, clean.

If you are in the hospital it is very important to make sure that your physician, nurses and any other staff wash their hands BEFORE and AFTER they come into your room to help prevent the spread of staph and MRSA from patient to patient. If you have MRSA and are hospitalized, the staff and even your visitors will be asked to wear protective clothing such as gowns and gloves while in your room.

 

 

Medication And Treatment

Minor staph infections can be treated with a simple antibiotic ointment. It is very important to keep the area clean, dry and covered. However, if you feel that your symptoms are not improving, or are getting worse, see a doctor right away. Your physician will culture the infection and prescribe you an oral antibiotic if needed. If the infection is severe enough, or does not improve with regular antibiotics, you may need to be hospitalized to have antibiotics through an IV. As well, your doctor may need to make a small incision and drain out the infection. Usually the doctor will leave the wound open with an antibacterial dressing inside, so that the infection can continue to drain. Your physician will later remove the material and the wound will usually heal and close on its own.

If the infection becomes very hard to treat, or is resistant to treatment, such as MRSA, your doctor will send you to see an infectious disease specialist. The following are antibiotics are used against staph and MRSA:

Staph:

  • Nafcillin
  • Cephalosporins
  • Sulfa Drugs
  • Vancomycin

MRSA: 

  • Vancomycin (often front-line therapy for MRSA)
  • Linezolid
  • Rifampin
  • Bactrim/Septra

 

Complementary and Alternative Treatment

The first line treatment for staph and MRSA infections is typically with antibiotics and good wound care. However, there is one particular natural remedy that has recently come to light: honey. Who knew something so sweet and delicious could also be used to kill these drug resistant bacteria? Medical grad manuka honey, or Medihoney, is the specific type used in the treatment of MRSA, and comes from honeybees that forage on the manuka tree, which grows in New Zealand. Honey of all kinds has been used traditionally for over a thousand years for clearing wound infections and to promote healing of chronic wounds, but manuka honey has been shown to have “broad spectrum” antimicrobial ability—it can act upon more than 80 species of pathogens. Clinical reports have shown that wound infections, including those that test positive for MRSA, can be cleared via topical application of manuka honey.

Manuka honey is particularly effective due to its potent antimicrobial properties.  Researchers have found that manuka honey affects the structure and activity of different bacteria, and as well, can impact the structure of antibiotics (specifically oxacillin and vancomycin), making them potentially more effective. In essence, this is reversing antibiotic resistance—and indicates that existing antibiotics can be made more effective if used in combination with manuka honey.

When To Contact A Doctor

It is important to see your doctor when your symptoms of a skin infection, wound or bite do not start to improve within a few days or if you have any of the following warning signs of a more serious infection:

  • Fever
  • Chills
  • Bone/joint pain
  • Difficulty breathing
  • Pain or tenderness in the infected area
  • Warmth to infected area

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What kind of test will I need?
  • Am I at risk for having MRSA?
  • How long should I take the antibiotics for?
  • Can I still attend work or school?
  • What are my options for treatment?
  • What treatment would you recommend, and why?
  • Am I contagious?
  • What are the possible side effects?
  • Does my insurance cover these treatments?
  • When should I come back if my symptoms don’t improve?