WHAT IS IT ABOUT MRSA THAT MAKES IT RESISTANT TO METHICILLIN?

The reason why MRSA is resistant to treatment with methicillin is because these bacteria have a particular gene in them called the mec gene. Genes are units of material contained in a person's cells that contain coded instructions as for how certain bodily characteristics (such as eye color) will develop. A cell is the smallest, most basic unit of life, that is capable of existing by itself.

Methicillin normally kills the Staphylococcus aureus by attaching to it, much like how a key fits into a lock. In this case, picture the methicillin as the key and the bacteria having a lock that the key fits into. The mec gene changes the shape of the site that methicillin would normally use to attach itself to the bacteria. This would be like trying to fit a house key into a different type of lock than the one it was originally meant to fit into. Thus, if methicillin cannot attach to the bacteria, the bacteria is resistant to it, which is why it is called MRSA.

HOW DO PEOPLE FEEL WHO ARE INFECTED WITH MRSA?

When people are infected with MRSA, they experience a fever and inflammation. Thus, someone with MRSA infection will likely feel hot, sweaty, uncomfortable, and experience chills during the infection. Patients who get infected with MRSA after a surgery may be in additional discomfort due to pain from the surgery. Emotional reactions vary, depending on the individual. Some people get very depressed and anxious, whereas others cope just fine. Depression may be caused from being isolated from others in the hospital for an extended period of time, the need to be treated with medications for several weeks, and reduced independence.

HOW MANY PEOPLE GET MRSA?

Infections due to MRSA have been a very serious problem in the United States since the mid-1970s. Currently, about 80,000 patients a year get a MRSA infection after entering the hospital.

WHO IS MOST LIKELY TO GET MRSA?

The people who are most likely to get MRSA are patients having surgery. Specifically, surgical patients with some type of disease who are in the hospital for a long time are at high-risk for getting MRSA. This is because their immune systems tend to be weak, making it difficult to fight off infections. Such patients are also at high risk for getting MRSA if they have received previous antibacterial treatment, were treated in an intensive care unit, or have been near another patient who has been exposed to MRSA. Surgical patients tend to get infected with MRSA at the site where they were cut open during the surgery.

Patients with open wounds (such as from burns or sores), elderly or very sick hospital patients, or people with a catheter (a tube going into the body) also have been known to get MRSA. Patients with abscesses (an opening containing pus and surrounded by inflammation) in the abdomen also get MRSA.

CAN HEALTHY PEOPLE GET MRSA?

It is quite rare for healthy individuals, including children, to get MRSA. However, MRSA has been found to occur in caregivers of sick individuals in their skin and on their nose. Other places where MRSA can be detected are in the urine and the blood. MRSA has been detected on some hospital burn units, but rarely is detected in the surrounding environment.

HOW DOES SOMEONE GET MRSA FROM SOMEONE ELSE?

MRSA is transmitted by contact. Typically, it is transmitted by the hands of hospital personnel who have touched something contaminated with MRSA and who did not wash their hands afterwards. Since MRSA is transmitted by contact, this means that there are ways to prevent it from spreading and infecting surgical patient.

HOW CAN MRSA BE PREVENTED FROM SPREADING?

When a patient has MRSA, it is essential that hospital personnel are careful to take precautions so as not to spread MRSA to other patients. To begin with, contact with the patient needs to be limited. This is why such patients will often be placed in a private room, a hospital practice known as isolation. This can usually last from a few days to a few weeks. Sometimes, however, a patient with MRSA is placed in a room with other patients infected with MRSA because there is no risk of one person spreading it to the other, since both are already infected.

To decrease the chances of a patient coming in contact with another patient exposed to MRSA, he/she should only be moved from the room when it is essential, such as for emergencies or medical procedures. Another obvious precaution is for personnel to wash their hands when dealing with the patient. Another solution is to clean and disinfect equipment used to care for patients. Also, hospital personnel and family members should wear gloves and a gown when in contact with the patient and material that is possibly contaminated. After leaving the room, the gloves and gown should be removed and the hands should be washed immediately.

Although healthy people are at low risk to get MRSA, it is worth it for them to take these precautions just in case. It is not considered to be a problem for healthy family members to be in the same room as a patient with MRSA. Casual contact, such as touching or hugging is also ok. Again, however, hands should be washed before leaving the room. These guidelines do not apply to sick individuals or those with weak immune systems, who are advised to limit their contact with a patient who has MRSA, and to wash hands their hands afterwards.

IS MRSA TREATABLE?

Yes. The good news about MRSA is that it is treatable with certain antibiotics. The bad news is that treatment is difficult. Eliminating the MRSA completely is very difficult. The drug of choice to treat most MRSA infections is an antibacterial drug called Vancomycin. Vancomycin is generally given over a period of 14 days to clear up the MRSA infection. However, antibiotic treatments can go on for months depending on the case.

Recent research has shown that the Vancomycin's ability to kill MRSA has gradually decreased from 1994 to 2000. This recent resistance to Vancomycin has made it even more important for new drugs to be developed to fight MRSA. Patients exposed to MRSA who are not infected with it do not usually need to be treated.

HOW LONG DOES IT NORMALLY TAKE FOR SOMEONE WITH MRSA TO GET BACK TO NORMAL?

The answer to this question depends on numerous factors, such as how long the MRSA has been present, the age of the patient, the presence of other medical problems, and the response to treatment. The longer the MRSA has been present, the older the patient is, the presence of other medical problems, and poor response to treatment are all factors that will generally make it take longer for the patient to return back to normal. That being said, many patients respond well to treatment with vancomycin in a 2 to 3 week period and return back to how they were before the infection.

WHAT IF SOMEONE DOES NOT RESPOND TO VANCOMYCIN TO TREAT MRSA?

If someone does not respond to vancomycin to treat MRSA, other antibacterial drugs can be used. Some doctors choose to have patients who have not responded to vancomycin to go for hyperbaric oxygen treatment while on antibacterial medications. Hyperbaric oxygen treatments involve having the patient breathe in oxygen at a pressure that is much higher than normal. Some bacteria cannot survive if they are exposed to excess oxygen.

The longer that MRSA continues to be in the body, the more problems can result. MRSA in the bloodstream can cause endocarditis (infection of heart valves), bone infection, and infection or failure of vital organs. The worst case scenario is that MRSA can cause death.

WHAT PRECAUTIONS SHOULD PATIENTS WITH MRSA TAKE WHO ARE DISCHARGED HOME?

If a patient with MRSA is discharged to go home, similar precautions to the ones discussed above should be followed such as hand washing and following good hygiene practices. Caregivers should continue to wear gloves when dealing with bodily fluids of the patient with MRSA. It is also considered a good idea to have the room of a patient with MRSA disinfected. These precautions should be followed until a physician states otherwise. You should also consult with your physician and nurse for any other additional precautions that may need to be taken.

WHAT ARE SOME LONG-TERM EFFECTS OF MRSA OR THINGS TO WATCH FOR?

One thing to watch out for is a reoccurrence of the MRSA infection. This can occur within a few months of the end of treatment because eliminating MRSA completely is very difficult. Signs and symptoms of a MRSA reinfection would be the same as when the infection was first discovered: fever, inflammation, feeling hot, sweaty, uncomfortable, and experiencing chills.

Even if MRSA was completely eliminated from the body, there can be long-term effects caused by the medication used to treat it. These long-term effects will depend on the particular medication used in treatment. For example, the most commonly used medication to treat MRSA, vancomycin, can cause hearing loss, although this is rare. In addition to asking a doctor or nurse about the side effects of medications, it is important to read about such side effects independently. This is because some medical professionals do not know or will forget to inform patients and family members of such side effects. Alternatively, they may consider the side effects as being so rare, that they are not worth mentioning.

DO PATIENTS WHO HAVE HAD A MRSA INFECTION NEED TO WEAR A MEDIC ALERT BRACELET IN CASE THEY ARE IN AN ACCIDENT?

It is certainly not a requirement for a person who has had a MRSA infection to wear a medic alert bracelet in case they are in an accident. However, if the patient is not opposed to wearing such a bracelet, this type of information would be helpful for a hospital to know. In sum, it is up to the patient whether to wear such a bracelet. The exception is if a patient is allergic to methicillin. In this case, the patient should definitely wear a medic alert bracelet to alert medical professionals in case of an accident.