Experts agree that MRSA (Methicillin-resistant Staphylococcus aureus ) can be hard to treat and contain. [1] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source It's a bacterial infection that doesn't respond well to the antibiotics usually used to fight infection. The infection spreads easily, especially in crowded conditions, and can rapidly become a threat to public health. Studies show that the early symptoms are sometimes confused for a harmless spider bite, so it's important to recognize MRSA immediately before it's allowed to spread. [2] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source
Steps
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Look for an abscess or boil. [3] X Trustworthy Source Centers for Disease Control and Prevention Main public health institute for the US, run by the Dept. of Health and Human Services Go to source The first symptom of MRSA is a raised, pus-filled abscess or boil that's firm to the touch and feels warm. This red blemish may have a “head” like a pimple, and can range in size from 2 to 6 centimeter (0.79 to 2.4 in) or larger. It can appear anywhere on the body, and will be extremely tender. For example, if it's on the buttocks, you likely won't be able to sit from the pain.
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Distinguish between MRSA boils and bug bites. [6] X Research source The early abscess or boil can look incredibly similar to a simple spider bite. One study showed that 30% of Americans who reported a spider bite were found to actually have MRSA. [7] X Research source Especially if you're aware of a MRSA outbreak in your area, err on the side of caution and get tested by a medical professional.
- In Los Angeles, MRSA outbreaks were so high the public health department raised billboards showing a picture of a MRSA abscess with the text “This is not a spider bite.”
- Patients didn’t take their antibiotics, believing their doctors were wrong and had misdiagnosed spider bites.
- Be vigilant for MRSA, and always follow medical advice.
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Watch for fever. Though not all patients get a fever, you may get one greater than 100.4°F (38°C). This can be accompanied by chills and nausea.
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Be alert for symptoms of sepsis. "Systemic toxicity" is rare, but possible if the MRSA infection is in the skin and soft tissue. While in most cases, patients can bide their time and wait for test results to confirm MRSA, sepsis is life threatening and needs immediate treatment. Symptoms include:
- Body temperature over 101.3°F (38.5°C) or below 95°F (35°C)
- Heart rate faster than 90 beats per minute
- Rapid breathing
- Swelling (edema) anywhere on the body
- Altered mental state (disorientation or unconsciousness, for example)
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Do not ignore symptoms. In some cases, MRSA might resolve on its own without treatment. [8] X Research source The boil may burst on its own, and your immune system may fight off the infection; however, MRSA can be more serious in people with weak immune systems. If the infection worsens, bacteria could make their way into the bloodstream, causing potentially fatal septic shock. Furthermore, the infection is highly contagious, and you could get a lot of other people sick if you neglect your own treatment.
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See a doctor for proper diagnosis. [9] X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source Most healthcare providers see many cases each week and should easily be able to diagnose MRSA. The most obvious diagnostic tool is the characteristic boils or abscesses. But for confirmation, the doctor will swab the site of the lesion and a lab will test it for the presence of the MRSA bacteria.
- However, it takes about 48 hours for the bacteria to grow, rendering immediate testing inaccurate. [10] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- New molecular tests that can detect MRSA’s DNA in a matter of hours are becoming more widely available. [11] X Research source
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Use a warm compress. [12] X Research source Hopefully, you saw a doctor as soon as you suspected MRSA and caught the infection before it became dangerous. The first, early treatment for MRSA is to press a warm compress against the boil to draw the pus to the surface of the skin. This way, when the doctor cuts the abscess to drain it, she'll be more successful in removing all the pus. Antibiotics may help speed up the process. In some cases, the combination of antibiotics and warm compresses may cause spontaneous draining without actually having to cut the lesion.
- Soak a clean washcloth in water.
- Microwave it for about two minutes, or until it's as warm as you can stand without burning your skin.
- Leave it on the lesion until the cloth cools down. Repeat the process three times per session.
- Repeat the entire warm compress session four times each day.
- When the boil has softened up and you can clearly see pus in the center of it, it is ready to be surgically drained by your doctor.
- Sometimes though, this can make the area worse. The heat pack may be quite painful and your wound may get bigger, redder, and much worse. Discontinue the heat packs and call your doctor if that happens.
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Allow a doctor to drain MRSA lesions. Once you've brought the bacteria-filled pus to the surface of the lesion, the doctor will cut it open and drain the pus out safely. First, she will anesthetize the area with Lidocaine and cleanse it with Betadine. Then, using a scalpel, she will make an incision in the "head" of the lesion and drain it of infectious pus. She will apply pressure all around the lesion, like pushing pus out of a popped zit, to make sure all infectious material is squeezed out. The doctor will send the extracted fluid to a lab to test it for responsiveness to antibiotics.
- Sometimes, there are honeycomb-like pockets of infections under the skin. These need to be broken up by using a Kelly clamp to hold the skin open while the doctor addresses the infection under the surface.
- Because MRSA is largely resistant to antibiotics, draining is the most effective way to treat it.
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Keep the wound clean. After draining, the doctor will wash out the wound with a needle-less syringe, then pack it tightly with strips of gauze. He'll leave a "wick" out so you can pull the gauze out at home to clean the wound in the same manner every day. Over time (usually about two weeks), the wound will get smaller and smaller until you can't fit gauze in it anymore. Until that happens, though, you should wash out the wound every day.
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Take any prescribed antibiotics. Don't pressure your doctor to prescribe antibiotics against her recommendation, as MRSA does not respond well to them. Over-prescribing antibiotics only helps infections become more resistant to treatment; however, there are two approaches to antibiotic treatments in general — for mild and for severe infections. Your doctor may suggest the following: [13] X Research source Guidelines of the Infectious Disease Society of America (IDSA), 2014: Increase in MRSA Prompts Updated Guidelines for Skin and Soft Tissue Infections( SSTI). June 9, 2014 statement.
- Mild to moderate infection: take one Bactrim DS tablet every 12 hours for two weeks. If you're allergic to it, take 100mg of Doxycycline on the same schedule.
- Severe infection (IV delivery): Receive 1 gm of Vancomycin through an IV for at least an hour; 600 mg of Linezolid every 12 hours; or 600 mg of Ceftaroline for at least an hour every 12 hours.
- The infectious disease consultant will determine the length of your IV therapy.
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Educate yourself on MRSA-preventing hygiene. [14] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source Because MRSA is so infectious, it's important that everyone in the community take be careful about hygiene and prevention, especially when there's a local outbreak.
- Use lotions and soaps from pump-bottles. Dipping your fingers into a jar of lotion or sharing a bar of soap with others can spread MRSA.
- Don't share personal items like razors, towels, or hairbrushes.
- Wash all bed linens at least once a week, and wash towels and washcloths after each use.
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Take extra care in shared or crowded spaces. [15] X Research source [16] X Research source Because MRSA spreads so easily, you must be especially aware of risks in crowded situations. These might include shared areas of a home or crowded public spaces like nursing homes, hospitals, prisons, and gyms. Though many common areas are regularly disinfected, you never know when the last cleaning was or who may have been in the area before you. It's wise to place a barrier down if you're concerned.
- For example, bring your own towel to the gym and place it between yourself and the equipment. Wash the towel immediately after use.
- Make good use of antibacterial wipes and solutions provided by the gym. Disinfect all equipment before and after use.
- If showering in a shared space, wear flip-flops or plastic shower shoes.
- You are at increased risk of infection if you have any cuts or have a compromised immune system (like with diabetes).
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Use hand sanitizer. Throughout the day, you come into contact with all sorts of shared bacteria. It may be that the person who touched a doorknob before you had MRSA, and touched his nose just before opening the door. It's a good idea to use hand sanitizer throughout the day, especially when in public. Ideally, the sanitizer will contain at least 60% alcohol.
- Use it at the supermarket, when receiving change from cashiers.
- Children should use hand sanitizer or wash their hands after playing with other children. Teachers who interact with children should follow the same standard.
- Whenever you feel you may be exposed to potential infection, use hand sanitizer just to be safe.
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Wash household surfaces with bleach. [17] X Research source A diluted bleach solution is effective at fighting the MRSA bug in your home. Incorporate it into your housekeeping routine during community outbreaks to decrease your risk of infection.
- Always dilute bleach before cleaning with it, as it could discolor your surfaces. [18] X Research source
- Use a 1:4 ratio of bleach to water. For example, add 1 cup of bleach to 4 cups of water to clean your household surfaces.
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Don't rely on vitamins or natural therapies. Studies have not been able to show that vitamins and natural therapies can improve our immune systems enough to ward off MRSA. The only study that seemed promising, in which subjects were given "mega-doses" of vitamin B3, had to be disavowed because the dosage itself was unsafe. [19] X Research source George Liu MD, Pierre Kyme, Nils Thoennisssen, Journal of Clinical Investigation, July 2012
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Learn the difference between the types of MRSA. When patients come into the hospital with MRSA, it is "community-acquired." "Hospital-acquired" MRSA is when a patient comes in the hospital for treatment of an unrelated condition, then gets MRSA while there. Hospital-acquired MRSA does not usually affect the skin and soft tissues, so you don't often see community-acquired boils and abscesses. These patients progress quickly to more serious complications.
- MRSA is a major cause of preventable death and is an epidemic in hospitals across the globe.
- The infection spreads quickly from patient to patient via unaware hospital staff who don't follow proper infection control procedures.
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Protect yourself with gloves. If you work in a medical setting, you absolutely must wear gloves when interacting with patients. But just as important as wearing gloves in the first place is changing gloves in between patients and washing your hands thoroughly each time you change gloves. If you don't change gloves, you may protect yourself from infection while spreading infection from one patient to the next.
- Infection control protocols vary from ward to ward, even within the same hospital. For example, infection is more prevalent in the intensive care unit (ICU), so contact and isolation precautions are usually stricter. Staff may be required to wear protective gowns and facemasks in addition to gloves. [20] X Research source Rosemarie Sadsad , Vitali Sintchenko, Geoff D MCdonell et al Effectiveness of Hospital-Wide Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) Infection Control Policies Differs by Ward Specialty, PLOS, December 2013 DOI 1371/journal.pone0083099
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Wash your hands regularly. [21] X Research source This is perhaps the most important practice for preventing the spread of infectious diseases. Gloves can't be worn at all times, so hand washing is the first line of defense against spreading bacteria.
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Pre-screen all new patients for MRSA. [22] X Research source Lance Peterson MD,To Screen or Not To Screen for Methicillin-Resistant <i>Staphylococcus aureus</i>. Journal of Clinical Microbiology, March 2010 Volume 48 no 3 683-689 [23] X Research source Robicsek, et al Annals of Internal Medicine 2008 148 409 -418 When you're dealing with patients' body fluids — whether through sneezing or through surgery — it's best to pre-screen for MRSA. Everyone in a crowded hospital setting is both a potential risk and potentially at risk. The test for MRSA is a simple nasal swab that can be analyzed within 15 hours. Screening all new admissions — even those who don’t show symptoms of MRSA — can cut down on the spread of infection. For example, one study showed that about 1/4 of preoperative patients who did not have any symptoms of MRSA were still carrying the bacteria.
- Screening all patients may not be reasonable within your hospital’s time and budget limits. You might consider screening all surgery patients or those whose fluids staff have to come into contact with.
- If the patient is found to have MRSA, the staff can decide on a “decolonization” strategy to prevent contamination during the surgery/procedure and transmission to other people in the health care setting. [24] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
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Isolate patients suspected to have MRSA. The last thing you want in a crowded hospital setting is for an infected patient to come into contact with uninfected patients there for other reasons. If single bed rooms are available, suspected MRSA patients should be isolated there. If that's not possible, MRSA patients should, at the very least, be quarantined into the same area, separate from the uninfected population.
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Make sure the hospital is well-staffed. When shifts are understaffed, overworked staff can "burn out" and lose focus. [25] X Research source Linda Aiken, et. al. “Implications of the California Nurse Staffing Mandate for Other States,” Health Services Research, 45.4 (August 2010). A well-rested nurse is more likely to follow infection control protocols carefully, thus reducing the risk of MRSA spreading through a hospital.
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Be vigilant for signs of hospital-acquired MRSA. In hospital settings, patients don't usually have the early abscess symptom. Patients with central venous lines are especially vulnerable to MRSA sepsis, and those on ventilators are at risk of MRSA pneumonia. [26] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source Both are potentially lethal. MRSA can also appear as a bone infection after knee or hip replacement, or as complication from surgery or wound infection. [27] X Research source These can also lead to potentially lethal septic shock.
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Follow procedure when placing central venous lines. [28] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source Whether placing the line or caring for it, lax hygiene standards can contaminate the blood and cause infection. Blood infections can go to the heart and get lodged on the heart valves. This causes "endocarditis," in which a large chunk of infectious material takes hold. This is extremely deadly.
- Treatment for endocarditis is surgical excision of the heart valve and a six week course of IV antibiotics to sterilize the blood.
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Take the time to maintain hygiene when handling ventilators. Many patients get MRSA pneumonia while on the ventilator. When the staff is inserting or manipulating the breathing tube that goes down the trachea, bacteria can be introduced. In emergency situations, staff may not find the time to properly wash their hands, but you should always make an effort to observe this important step. If there's not time to wash your hands, at least put on a pair of sterile gloves.
Expert Q&A
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QuestionI have MRSA. Should I ask my doctor about a cure?Dr. Litza is a Board Certified Family Medicine Physician based in Racine, Wisconsin. With over 25 years of educational and professional experience, she has extensive experience providing full-spectrum Family Medicine, including obstetrics, newborn care, and hospital medicine. She is currently the Residency Program Director for Family Medicine at Ascension. Dr. Litza received her MD from the University of Wisconsin-Madison School of Medicine and Public Health and has completed additional fellowship training in Integrative Medicine through the University of Arizona.Depends on how you have been diagnosed. If you had a sore and completed treatment and you are doing well, then there is often nothing more to do other than monitor for a recurrence. MRSA may live on your body, colonized, for months or years even with treatment, so the best approach is good hygiene and monitoring so the bacteria doesn’t start to grow where your body can’t handle it (open sores on skin, for example).
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QuestionCan MRSA be cured?Dr. Ziadie is a board certified Pathologist in South Florida. She specializes in renal, transplant, and pediatric Pathology and has over 12 years of experience. She earned her medical degree from the University of Miami School of Medicine in 2004 and completed her fellowship in Pediatric Pathology at Children’s Medical Center in 2010.MRSA infections can be cured but they require long courses of antibiotics. Surgical treatment of skin infections ("incision and drainage") may also be required.
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QuestionOnce you are diagnosed with MRSA do you always have it?Dr. Ziadie is a board certified Pathologist in South Florida. She specializes in renal, transplant, and pediatric Pathology and has over 12 years of experience. She earned her medical degree from the University of Miami School of Medicine in 2004 and completed her fellowship in Pediatric Pathology at Children’s Medical Center in 2010.You can get rid of MRSA, but it is a long process that includes environmental disinfection and a long course of antibiotics. Many people are carriers of the bacteria (their body allows it to live on its surface without really causing an infection) and can spread the bacteria to others who may be more susceptible (elderly people, children, people with HIV or other illnesses, etc). If you have been identified as a carrier, ask your healthcare provider to give you instructions on how to reduce your risk to others.
Tips
- Wash and disinfect linen, clothes, and towels that come into contact with the affected area of the skin.Thanks
- Practice good hygiene at all times. For instance, ensure you wipe and disinfect any surfaces exposed to the wound, for example, doorknobs, light switches, counter-tops, bathtubs, sinks, and other household fixtures since an infected person can transfer the bacteria to such surfaces by touching them.Thanks
- Cover any open cuts, scrapes, or wounds with a clean band-aid until they heal completely.Thanks
Warnings
- MRSA skin infections are quite sensitive in nature. You should not attempt to pop, drain, or squeeze boils. If you do so, you are likely to worsen the infection, and possibly spread it to others. Instead, cover the infected area, and consult a healthcare specialist to deal with the issue.Thanks
- For patients with weak immune systems, MRSA infection could potentially be life threatening because it is quite difficult to treat, especially once it reaches the lungs and gets into the bloodstream. In such cases, patients often require long hospitalization, treatment, and monitoring.Thanks
- Some people are MRSA carriers. In other words, such people usually have the bacteria on their skin but do not get infections due to the bacteria. Your doctor might suggest testing people who you normally close to you to confirm whether any of them is a carrier. Nurses normally obtain test samples by swabbing patients' nostrils. For MRSA carriers, doctors normally prescribe a continuous antibiotic dosage to eradicate bacteria colonization completely.Thanks
- Bacterial strains such as MRSA are quite adaptive in nature and can easily develop resistance against common antimicrobial drugs. As such, you should strictly adhere to your prescription antibiotics, which you should not share with anyone else.Thanks
- Avoid swimming pools, hot tubs, or any kind of recreational water until the wound closes. Chemicals in the water can make your infection much worse, and spread the infection into the water.Thanks
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References
- ↑ https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336
- ↑ https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336
- ↑ https://www.cdc.gov/mrsa/media/pdfs/provider-brochure-p.pdf
- ↑ http://www.nlm.nih.gov/medlineplus/streptococcalinfections.html
- ↑ http://emedicine.medscape.com/article/971358-overview
- ↑ http://www.lapublichealth.org/wwwfiles/ph/ph/ph/TPH0203.pdf
- ↑ http://www.livescience.com/37974-he-surprising-cause-of-most-spider-bites.html
- ↑ https://www.rmh.org/programs-and-services/methicillin-resistant-staphylococcus-aureus-mrsa-fact-sheet
- ↑ http://www.mayoclinic.org/diseases-conditions/mrsa/basics/tests-diagnosis/con-20024479
- ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2650924/
- ↑ https://labtestsonline.org/understanding/analytes/mrsa/tab/test/
- ↑ https://kidshealth.org/en/parents/abscess.html
- ↑ Guidelines of the Infectious Disease Society of America (IDSA), 2014: Increase in MRSA Prompts Updated Guidelines for Skin and Soft Tissue Infections( SSTI). June 9, 2014 statement.
- ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528015/
- ↑ http://www.scientificamerican.com/article/mrsa-spreads-in-households/
- ↑ http://www.phila.gov/health/pdfs/CA-MRSA_guidelines.pdf
- ↑ https://www.health.state.mn.us/diseases/staph/mrsa/book.pdf
- ↑ https://www.clorox.com/dr-laundry/making-sure-you-dilute-bleach/
- ↑ George Liu MD, Pierre Kyme, Nils Thoennisssen, Journal of Clinical Investigation, July 2012
- ↑ Rosemarie Sadsad , Vitali Sintchenko, Geoff D MCdonell et al Effectiveness of Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Control Policies Differs by Ward Specialty, PLOS, December 2013 DOI 1371/journal.pone0083099
- ↑ http://patient.info/health/mrsa-leaflet
- ↑ Lance Peterson MD,To Screen or Not To Screen for Methicillin-Resistant Staphylococcus aureus . Journal of Clinical Microbiology, March 2010 Volume 48 no 3 683-689
- ↑ Robicsek, et al Annals of Internal Medicine 2008 148 409 -418
- ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411148/
- ↑ Linda Aiken, et. al. “Implications of the California Nurse Staffing Mandate for Other States,” Health Services Research, 45.4 (August 2010).
- ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108742/
- ↑ http://mrsamd.com/no,44
- ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108742/
About This Article
To get rid of MRSA, start by placing a warm compress against the raised boil four times a day so you can draw the fluids to the surface. Once the boil has softened considerably and you can see pus at the center, go to your doctor to have the lesion lanced and drained to remove the infection. Afterward, keep the area covered with sterile gauze and clean the wound every day for 2 weeks, or until it’s completely healed. For tips from our Medical reviewer on how to prevent a MRSA infection from spreading, read on!
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- "Great tips, & it explains most subjects very well, more than any other site I've been to! Thank you so much. All hospitals should have a refresher course on sterilization! It would definitely make an impact on spreading of MRSA to the public. This should be a law!" ..." more