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MRSA Infection (cont.)

How is MRSA diagnosed?

A skin sample, sample of pus from a wound, or blood, urine, or biopsy material (tissue sample) is sent to a microbiology lab and cultured for S. aureus. If S. aureus is isolated (grown on a Petri plate), the bacteria are then exposed to different antibiotics including methicillin. S. aureus that grows well when methicillin is in the culture are termed MRSA, and the patient is diagnosed as MRSA-infected. The same procedure is done to determine if someone is an MRSA carrier (screening for a carrier), but sample skin or mucous membrane sites are only swabbed, not biopsied.

In 2008, the U.S. Food and Drug Administration (FDA) approved a rapid blood test that can detect the presence of MRSA genetic material in a blood sample in as little as two hours. The test is also able to determine whether the genetic material is from MRSA or from less dangerous Staph bacteria. The test is not recommended for use in monitoring treatment of MRSA infections and should not be used as the only basis for the diagnosis of a MRSA infection.

How can people prevent MRSA infection?

Not making direct contact with skin, clothing, and any items that come in contact with either MRSA patients or MRSA carriers is the best way to avoid MRSA infection. In many instances, this situation is simply not practical because such infected individuals or carriers are not immediately identifiable. What people can do is to treat and cover (for example, antiseptic cream and a Band-Aid) any skin breaks and use excellent hygiene practices (for example, hand washing with soap after personal contact or toilet use, washing clothes that potentially came in contact with MRSA patients or carriers, and using disposable items when treating MRSA patients). Also available at most stores are antiseptic solutions and wipes to both clean hands and surfaces that may contact MRSA. These measures help control the spread of MRSA.

Pregnant women need to consult with their doctors if they are infected or are carriers of MRSA. Although MRSA is not transmitted to infants by breastfeeding, there are a few reports that infants can be infected by their mothers who have MRSA, but this seems to be an infrequent situation. Some pregnant MRSA carriers have been successfully treated with the antibiotic mupirocin cream.

What are the prognosis (outlook) and complications for people with MRSA infections?

Currently available statistics from the Kaiser foundation in 2007 (http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45809) indicate that about 1.2 million hospitalized patients have MRSA, and the mortality (death) rate was estimated to be between 4%-10%. Another study suggested that the mortality rate may be as high as 23%. Fortunately, in children under 18 years of age, a recent (2009) study suggests their mortality rate is much lower (about 1%), even though the number of hospitalized children with MRSA has almost tripled since 2002. In general, CA-MRSA has far less risk of any complications than HA-MRSA as long as the patient does well with treatment and does not require hospitalization. However, people that do get complications generally have a chance for a worse outcome, as organ systems may be irreversibly damaged. Complications can occur in almost all organ systems; the following is a listing of some that can result in permanent organ damage or death: endocarditis, kidney or lung infections, necrotizing fasciitis, osteomyelitis, and sepsis. Early diagnosis and treatment usually result in better outcomes and reduction or elimination of further complications.



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