MRSA infection

Introduction

MRSA is a type of bacterial infection that is resistant to a number of widely used antibiotics. This means it can be more difficult to treat than other bacterial infections.

The full name of MRSA is meticillin-resistant staphylococcus aureus. You may have heard it called a superbug.

Staphylococcus aureus (also known as staph) is a common type of bacteria. It is often carried on the skin, inside the nostrils and the throat and can cause mild infections of the skin, such as boils and impetigo.

If staph bacteria get into a break in the skin, they can cause life-threatening infections, such as blood poisoning or endocarditis (an infection of the inner lining of the heart).

How bacteria become resistant to antibiotics

Antibiotic resistance can occur in several ways.

Strains of bacteria can mutate and over time become resistant to a specific antibiotic.

Alternatively, if you are treated with an antibiotic, it can destroy many of the harmless strains of bacteria that live in and on the body. This allows resistant bacteria to quickly multiply and take their place.

The overuse of antibiotics in recent years has played a major part in antibiotic resistance. This includes using antibiotics to treat minor conditions that would have got better anyway or not finishing a recommended course of antibiotics.

How do you get MRSA?

MRSA infections are more common in people who are in hospital or nursing homes. Doctors often refer to this as healthcare-associated MRSA (or HA-MRSA).

Hospital patients are more at risk because:

They often have an entry point for the bacteria to get into their body, such as a surgical wound, burn or a intravenous drip (a tube used to give fluids directly into a vein).
They are usually older and weaker, which makes them more vulnerable to infection.
They are surrounded by a large number of people, which means bacteria can easily spread through direct contact with other patients or staff or contaminated surfaces.

More recently, MRSA has been known to develop outside hospitals and nursing homes. This is known as community-associated MRSA (or CA-MRSA). It is more common in crowded environments where there is frequent skin-to-skin contact and hygiene is poor, such as homeless shelters or army bases.

Preventing MRSA

In recent years, rates of MRSA have fallen because of increased awareness of the infection by both medical staff and the public. However, MRSA still places a considerable strain on healthcare services.

To reduce your risk of an MRSA infection:

Wash your hands before and after visiting someone in a care home (many hospitals provide antibacterial gel in wards).
If you are going into hospital for an operation, ask to be screened for MRSA (see below).
Speak to Dr. B C Shah if you have any concerns about hygiene in your hospital.
Put all disposable items, such as dressings, into the appropriate bins promptly.

Screening for MRSA

Most patients who are admitted to hospital for a planned procedure are screened for MRSA. This helps reduce the chance of patients developing an MRSA infection or passing an infection on to other patients.

Treating MRSA

Minor skin infections may not require any treatment other than draining away any pus from the site of the infection.

Otherwise, infections can be treated with antibiotics that MRSA has not yet developed resistance to. The exact antibiotic that is used will depend on the specific strain of MRSA involved.

Depending on the severity of your symptoms, antibiotic tablets or injections will be used and you may need to have a much longer course of treatment compared to a normal staph infection.

Common questions about MRSA

Can someone with an MRSA infection have visitors?
What are the risks of MRSA during pregnancy?

Symptoms of MRSA infection

The symptoms of an MRSA infection will depend on what part of the body is infected. Many people carry the MRSA bacteria inside their nose but will never have any symptoms.

Skin and soft tissue MRSA infections

Boils and abscesses

An MRSA skin infection usually first develops as a painful bump or a mark in the skin that looks like an insect bite. The bacteria often enter the skin through a cut, graze or a hair follicle. This develops into a painful, pus-filled swelling (boil).

Some people have additional symptoms, such as a high temperature and a general feeling of being unwell.

In some cases, MRSA can cause a larger, pus-filled lump to develop underneath the skin. This is known as an abscess.

Cellulitis

MRSA contracted outside hospitals or care homes (called community-associated MRSA or CA-MRSA) often causes more extensive skin infections, including a type of infection called cellulitis.

Cellulitis is a bacterial infection of the deeper layers of skin and the layer of fat and soft tissues underneath the skin. The main symptom is the skin suddenly turning red, painful, hot and swollen.

Invasive MRSA infections

If the MRSA bacteria penetrate deeper inside your body or into your blood, they can cause serious infections.

Signs that you may have an invasive infection include:

A high temperature (fever) of 38C (100.4F) or above
Chills
A general sense of feeling unwell
Dizziness
Confusion
Muscular aches and pains
Pain, swelling and tenderness in the affected body part

Invasive MRSA infections can lead to the following conditions:

Blood poisoning
Urinary tract infection – infection of the parts of the body used to take urine out of the body, such as the bladder
Infection of the lining of the heart (endocarditis)
Septic bursitis
Septic arthritis
Osteomyelitis

Causes of MRSA infection

MRSA is caused by strains of bacteria that have developed resistance to a number of widely used antibiotics.

How MRSA spreads

MRSA bacteria are usually spread through skin-to-skin contact with someone who has an MRSA infection or who is colonised by the bacteria. Colonised means bacteria are present on your body but do not cause any symptoms.

The bacteria can also spread through contact with towels, sheets, clothes, dressings or other objects that have been used by a person who is infected with or colonised by MRSA.

MRSA can survive for long periods on objects or surfaces, such as door handles, sinks, floors and cleaning equipment.

Healthcare-associated MRSA (HA-MRSA)

It is much more common for someone to develop MRSA while they are in hospital or a care home than in the community. This is because:

People in hospital often have a point that allows bacteria to enter their body, such as a surgical wound, burn, catheter (a tube used to drain away urine) or an intravenous tube. If a patient who is colonised with MRSA bacteria touches their wound or catheter tube, they may infect themselves.
People in hospital tend to be older and have more complex health problems than the general population, which makes them more vulnerable to infection.
People in hospital are surrounded by a large number of people, both patients and staff. This makes it is easier for bacteria to spread from person to person, or from a person to an object and then to another person.

Who is at risk?

Factors that increase your chance of developing HA-MRSA include:

A weakened immune system, for example in elderly people, newborn babies and people with a long-term health condition, such as type 2 diabetes
An open wound
A catheter or an intravenous drip
A burn or cut on the skin
A severe skin condition, such as a leg ulcer or psoriasis
Surgery
Taking frequent courses of antibiotics

MRSA infections usually develop in people being treated in hospital, particularly patients in intensive care units (ICUs) and on surgical wards.

Community-associated MRSA

MRSA contracted outside hospitals is known as community-associated MRSA (CA-MRSA). It’s much less common than HA-MRSA.

However, in recent years the number of cases has increased and could continue to increase in the future. The following factors increase your risk of getting CA-MRSA:

Living in a very crowded environment – for example a military base, prison or student hall of residence
Frequent skin-to-skin contact – outbreaks of CA-MRSA have been reported in people who play contact sports, such as rugby
Cut or grazed skin – this is more vulnerable to infection, as are people who regularly inject illegal drugs, such as heroin
Contaminated items and surfaces – places where many people share utensils, tools or where many people are likely to touch the same surfaces
Lack of cleanliness – outbreaks of MRSA can occur in homeless people or in people on active military duty who have limited access to cleaning facilities
Previous use of antibiotics

Diagnosing MRSA infection

An MRSA infection is most commonly diagnosed using a blood, urine, tissue or sputum (spit) culture.

This involves taking a sample of one or more of these substances and placing them in a dish of nutrients. This should encourage any staph bacteria that are present to reproduce and grow.

If the bacteria develop, different antibiotics can be directed at them to see if the bacteria have developed resistance to the antibiotics.

This type of test is often used to screen people before they are admitted to hospital to help reduce rates of MRSA.

Treating MRSA infection

If you are diagnosed with an MRSA infection, your recommended treatment plan will depend on:

The type of infection you have
The site of the infection
The severity of your symptoms
The antibiotics that the specific strain of MSRA is sensitive to

A number of possible treatment plans are outlined below.

Skin and soft tissue infections

Minor skin and soft tissue infections, such as smaller boils or abscesses, may only require a treatment called incision and drainage.

Incision and drainage involves piercing the tip of the boil or abscess with a sterile needle or scalpel. This encourages the pus to drain out, which should help relieve pain and stimulate the recovery process. Before having the procedure, you are likely to be given a local anaesthetic to numb the affected area.

More extensive skin infections, such as cellulitis (an infection of the underlying layers of skin), will usually require a 5- to 10-day course of antibiotic tablets.

It is hard to predict what antibiotic you will be given. The choice depends on the result of testing and, in some cases, what part of the country you live in.

You’re likely to be given a 7- to 14-day course of antibiotic injections if you develop a skin or soft tissue infection in hospital and you’re more vulnerable to the effects of the infection. This might be because you have burns or a surgical wound.

Invasive infections

If you develop MRSA in hospital, it’s likely that you will need to be transferred to an isolation room. This reduces the risk of the infection spreading to other patients.

You may be placed in a room by yourself or in a small ward with other people who have an MRSA infection. You should still be able to have visitors, but it is very important that they clean their hands thoroughly before and after visiting you and before and after touching you.

Treatment for an invasive MRSA infection will involve a course of antibiotic injections. Depending on the type and location of the infection, this could last up to six weeks.

A combination of antibiotics may be used.

Click on the links below for more information about different types of invasive infection:

Blood poisoning
Bursitis
Endocarditis
Meningitis
Osteomyelitis
Pneumonia
Toxic shock syndrome

Preventing MRSA infection

Preventing healthcare-associated MRSA

Hospital staff, patients and hospital visitors can take simple hygiene measures to help prevent the spread of MRSA and stop infection.

Patients

Hospital patients can reduce their risk of infection by:

Always washing their hands after using the toilet or commode (many hospitals now routinely offer hand wipes)
Always washing their hands or cleaning them with a hand wipe immediately before and after eating a meal
Making sure their bed area is regularly cleaned and reporting any unclean toilet or bathroom facilities to staff

Visitors

Visitors can reduce the chance of spreading MRSA to other people by not sitting on the patient’s bed and by cleaning their hands before and after entering the ward. They should use hand wipes or hand gel before touching the person they are visiting.

Hand gel or hand wipe dispensers are often placed by patients’ beds and at the entrance to clinical areas.

Hospital staff

Hospital staff who come into contact with patients should maintain very high standards of hygiene and take extra care when treating patients with MRSA:

Staff should thoroughly wash and dry their hands before and after caring for a patient, before and after touching any potentially contaminated equipment or dressings, after bed making and before handling food.
Hands can be washed with soap and water or, if they are not visibly dirty, a fast-acting antiseptic solution like a hand wipe or hand gel.
Disposable gloves should be worn when staff have physical contact with open wounds, for example when changing dressings, handling needles or inserting an intravenous drip. Hands should be washed after gloves are removed.
The hospital environment, including floors, toilets and beds, should be kept as clean and dry as possible.
Patients with a known or suspected MRSA infection should be isolated.
Patients should only be transferred between wards when this is strictly necessary.

These steps aim to reduce the chance of patients infecting themselves and others.

Preventing community-associated MRSA

The following advice will help reduce your risk of catching or passing on MRSA outside hospital:

Regularly wash your hands and have frequent showers or baths.
Keep your fingernails short and clean because bacteria can grow under larger nails.
Do not share any products that come into contact with your skin, such as soaps, lotions, creams and cosmetics.
Do not share unwashed towels.
Do not share any personal items that come into contact with your skin, such as razors, nail files, combs or hairbrushes, without thoroughly cleaning them first.

If you develop a skin or soft tissue MRSA infection:

Cover it with a dressing unless you are told not to by the doctor in charge of your care.
Wash your hands after touching affected areas of skin and potentially infected materials, such as used dressings.
Dispose of any potentially infected material promptly and safely in a dustbin or similar.

Screening: frequently asked questions

Why am I being screened for MRSA?
When and where will I be screened for MRSA?
How will I be screened for MRSA?
When will I get the results from the swabs?
What happens after I have been screened?
What happens if I am a carrier of MRSA?
What treatment is used to get rid of MRSA from my skin?
What if my operation is urgent?

Why am I being screened for MRSA?

Many people carry MRSA on their skin or in their nose.

If the hospital can find out if you are carrying MRSA before you go in, it can use a simple treatment to get rid of as much of the bacteria as possible. This means that there is a much smaller chance of you getting an MRSA infection or passing MRSA on to another patient.

When and where will I be screened for MRSA?

Usually you will be screened before you come into hospital for an operation.

Typically, a nurse will take swabs as part of other checks, such as blood pressure and blood tests, leading up to your hospital stay.

How will I be screened for MRSA?

Dr. B C Shah can find out if you are carrying MRSA by taking a sample of bacteria using a swab. A swab is a cotton bud that is placed on the area of skin to be tested. Swabs may be taken from different places, such as the inside of your nose, your armpit or your groin. Swabbing is painless and only takes a few seconds.

When will I get the results from the swabs?

Your swabs will be sent to a laboratory, which tests them for MRSA. The results usually take three to five days, but may come back on the same day.

What happens after I have been screened?

If you are found to be carrying MRSA on your skin or in your nose, you will be contacted by the hospital or Dr. B C Shah. Don’t worry if you are contacted. Many people carry MRSA. Carrying MRSA does not make you ill and you are not a risk to healthy people. Healthy older people, pregnant women and children are not usually affected by MRSA.Dr. B C Shah will let you know what you need to do next.

If you are not carrying MRSA, you are unlikely to be contacted. If you are not contacted, continue with your hospital care as planned.

What happens if I am a carrier of MRSA?

If you are carrying MRSA on your skin, you may not be able to have your planned operation or procedure straight away. You may need to be treated for MRSA first to protect you and other patients from getting ill.

What treatment is used to get rid of MRSA from my skin?

Dr. B C Shah will discuss treatment with you. It usually involves using an antibacterial wash or powder and a special cream in your nose.

You may be asked to change your clothes, sheets and pillowcases every day, usually for five days.

You do not need to be in hospital while you are using the treatment. Continue until the day of your operation or procedure or until the five days are complete. You do not usually need to be screened again before you come into hospital.

What if my operation is urgent?

If your operation is urgent and you need to go into hospital quickly, you may be admitted to a side room in the hospital and started on MRSA treatment as soon as possible.