HA-MRSA – Healthcare-Acquired MRSA

Approximately 2 – 10% of the U.S. population is now colonized with MRSA. MRSA can cause serious infections such as:

• Surgical site wound infections
• Bloodstream infections
• Pneumonia

Methicillin is an antibiotic that belongs to a class of penicillin-related antibiotics called beta-lactams. Doctors often prescribe beta-lactams to treat staph infections and over time some strains have become resistant to beta-lactams, which means these antibiotics can’t kill them. Doctors refer to these organisms as methicillin-resistant staph bacteria. MRSA infections typically are resistant to a variety of antibiotics from other antibiotic classes as well and this can make treatment very difficult. Healthcare-acquired MRSA infections happen frequently in hospitals, rehab facilities, nursing homes and have been increasing in alarming rates for decades. MRSA is becoming more prevalent in healthcare settings due to lapses in infection control. If a person is colonized, they have a 8-12 fold greater chance of getting an infection. A comprehensive approach is required to prevent infections:

• Screening – active detection isolation (ADI)
• Isolation in an appropriate manor – gloves and gown used by all who enter the room. Designated equipment such as stethoscope are left in the patients room.
• Strict adherence to hand hygiene (handwashing)
• Routine environmental decontamination of equipment and frequently touched surfaces.
• Prudent use of antibiotics and patients finishing their full course of antibiotics.

Most infections are acquired by contact with a healthcare worker with contaminated hands or equipment. IV antibiotics such as vancomycin is administered. An infection can enter the bloodstream causing sepsis and 25% of patients with sepsis die.

MRSA Infections Develop in:

• Patients in healthcare facilities of all ages and particularly in the elderly
• People who have been exposed to chronic healthcare environments such as dialysis centers, nursing homes and rehab facilities.

Symptoms

MRSA infections can cause a broad range of symptoms depending on the part of the body that is infected. These include: surgical wounds, burns, catheter sites, eye, skin and blood. People who are colonized with MRSA may never develop an infection but have a 8-12 fold greater chance of doing so.

MRSA can cause urinary tract infections (UTI), septecemia, toxic shock and death. MRSA may also enter the bone marrow causing osteomyelitis and destroy hearts valves causing endocaritis. The sooner treatment is administered the better outcome.

People who are colonized with MRSA have no symptoms. They can carry MRSA in their nose and on their skin for many years. Staph skin infections often begin with an injury and develop into an infection. Symptoms are:

• Redness, warmth, swelling, tenderness of the skin and boils and blisters.
• Some people may have chills and fever, fell nauseous and acute pain.
• Staph infections are especially dangerous to those who have had surgery and may have a cast or heavy bandages that are not changed frequently.
• In serious cases, the patient may feel lethargic (fatigue) and have headaches.

Transmission

MRSA can be acquired by direct contact with an infected or colonized person and contaminated objects. The lack of decontaminating surfaces and environmental cleaning in healthcare facilities has lead to the spread of MRSA and lapses in infection control. Healthcare-acquired MRSA infections happen frequently in hospitals, rehab facilities, nursing homes and have been increasing in alarming rates for decades. Active detection isolation (ADI) is imperative to reducing MRSA infections along with strict adherence to hand hygiene. Most infections are acquired by contact with a healthcare worker with contaminated hands or equipment. IV antibiotics such as vancomycin is administered. The infection can enter the bloodstream causing sepsis and 25% of patients with sepsis die.

Patients must insist that healthcare workers wash their hands first and then put on gloves before touching the patient. Healthcare workers must also wash their hands again before leaving the room. Insist upon it, it is your life.

Mental and Emotional Effects

The healthcare community has not addressed the psychological effects that a traumatic MRSA infection or subsequent chronic disease can have on a patient. The whole patient must be treated, not just the infection. Many MRSA survivors feel very angry about what has happened to them and they know that this was preventable. Many feel betrayed by their doctor and hospital as over half of MRSA patients are not told that they have MRSA and that it is treatable, but not curable. Doctors and healthcare facilities need to be honest with their patients and disclose the truth, otherwise a patients’ rights have been violated and more emotional damage is done. And a simple, “I’m so sorry that this has happened to you”, would help a MRSA survivor greatly. MRSA patients can suffer from the following, which can impede their healing:

• Depression
• Anger
• Post traumatic stress disorder (PTSD)
• Anxiety

High Risk Patients

MRSA can cause infections in healthy and ill patients of all ages. Most MRSA infections occur in patients 65 years or older. Patients who are seriously ill and and from nursing homes have a high occurrence also. High risk patients are the following and should be screened: screening is done with a simple nasal swab to the nares)

• Patients coming from a nursing home or another healthcare facility
• Dialysis patients
• Those previously colonized or with MRSA infections
• The homeless
• Inmates
• ICU patients
• Those who have been in a hospital in the last few years
• Surgical patients receiving implants

MRSA Osteomyelitis

Osteomyelitis is an infection of the bone and bone marrow that can destroy the bone and cause deformity or result in amputation if not treated. MRSA osteomyelitis is when the pathogen causing the infection to the bone is identified as MRSA. Osteomyelitis is mostly caused by staph.

Osteomyelitis was a major cause of disability and even death, but it now can be treated more effectively with antibiotics and surgery. Osteomyelitis presents most frequently in adults after surgery with an implant, but can also suddenly appear for no apparent reason, which is more common in children.

Symptoms are:

• Severe pain in the area where you have an infection
• Fever, nausea or feeling of unwellness.
• Swelling in the affected area
• Unable to move the affected limb or area with severe pain

Complications

First development of osteomyelitis is called acute osteomyelitis and typically over very quickly when treated promptly. If not treated in a timely fashion or the affected area is not responding to treatment, then this can be categorized as chronic osteomyelitis and part of the bone may die. The infection may go on for several months or even years. Flare-ups of symptoms including fever and pain may occur for many years. Septic arthritis can develop if the pus from the infection discharges into the joint rather than exiting through the skin. If not treated immediately, this can infect and damage the joint, which limits movement.

Causes

Osteomyelitis can be caused by staph or other pathogens or the combination of organisms. At risk persons are:

• Patient with broken bones or have had surgery
• Joint replacement
• Patients with an infection and the infection spreads to the bone and bloodstream, most often with children and elderly
• Diabetic patients who are prone to infections in the feet
• Patient with a weakened immune system from chemotheraphy, etc.

Diagnosis

Most patients are in the hospital and feel acute symptoms which can be osteomyelitis and blood tests, culture or a bone biopsy can be performed. Appropriate antibiotics will be prescribed which most often is by IV and then possibly by oral, depending on the severity. Surgery as well as antibiotics may be needed and the surgeon will confirm with imaging tests.

MRSA Pneumonia

Pneumonia is an inflammation of the lungs, usually caused by an infection, which can be mild to life-threatening. Viruses, fungi, parasites and bacteria can cause pneumonia. If the bacteria are identified as MRSA, then you will have MRSA pneumonia. MRSA pneumonia is highly antibiotic resistant and most common in patients 65 years or older.

Symptoms are:

• Fever, sweating
• Cough, chest pain, Shortness of breathe
• Muscle pain, fatigue, headaches and chills

Hospital-acquired Pneumonia

A patient is at a higher risk for pneumonia if hospitalized, on a ventilator, in the intensive care unit (ICU) or have a weakened immune system. Pneumonia can be difficult to determine at times. MRSA can enter a patient from a catheter, wound and possibly in the air in the case of MRSA pneumonia. Patients can have been previously colonized with MRSA.

Community-acquired Pneumonia

Pneumonia that is acquired in daily life is most commonly bacterium Streptococcus pneumonia and the lesser common cause Mycoplasma pneumonia. Walking pneumonia, a term used for a type of pneumonia that does not require bed rest may be Mycoplama pneumonia.

At  Risk

High risk patient that are at risk for contracting pneumonia are:  65 years and older, possess immune deficiency diseases such as HIV/AIDS, emphysema, diabetes or on an immunosuppressant medication, smoke, abuse alcohol, in an ICU, experienced a surgery or injury, chemical or pollutant exposure, COPD patient, a native Alaskan or an American Indian tribe member.

Complications

State of health, age and lifestyle can be a determining factor in the outcome for pneumonia. MRSA can enter a patients’ bloodstream and cause life-threatening inflammation. Breathing becomes difficult and the infection can spread quickly to other organs. Fluid can accumulate and spread to the lungs causing pleurisy. Pus can form in the cavity and cause a lung abscess. Pneumonia can involve a majority of the lungs and breathing becomes difficult and deprives the body of oxygen, resulting in acute respiratory distress syndrome (ARDS).

Hope Award

Jeanine Thomas, founder of MRSA Survivors Network receives MITTS Hope Award 2015.

Ms. Thomas received the prestigious MITTS Hope Award from the Boston medical community for her work in helping patients and families with MRSA and also for raising awareness to the ongoing MRSA epidemic. She receive the award during a gala event at the Boston Sheraton on November 9, 2015.