The incidence of Methicillin Resistant Staphyloccus Aureus (MRSA) infection has risen in recent years. MRSA refers to any staphylococcal infection that is resistant to the most commonly administered antibiotic. Until recently, MRSA was most often isolated in hospitals and long term care facilities. Now, due to increased antibiotic resistance, outbreaks are seen more often in the community. These infections, often in the form of skin lesions or boils, although sometimes causing serious infections such as pneumonia, resist the most commonly prescribed antibiotics. Individuals often carry this type of Staphyloccus on the skin and in the nose, referred to as colonization, but it may poses a problem if it enters the body through a break in the skin. Some people carry this organism and never become ill, however, they can pass the infection on to others.

Those who inject drugs, insulin dependent diabetics, people with dermatological conditions, those who have received antibiotics recently, people with recent hospitalizations and health care workers are more susceptible to MRSA. However, anyone who comes in contact with a carrier of MRSA can contract it. The infection usually begins as a skin or soft tissue lesion or cellulitis. The lesion initially looks like a pimple or a spider bite. Pictures of these skin lesions can be found on the Dermatlas website. In some cases, if not identified in the early stages, a serious infection, such as pneumonia can occur.

If you suspect a student has MRSA, first culture the lesion and then begin treatment on center. If the student presents with what is suspected to be a systemic infection, s/he should be sent to an emergency department. The student's roommates and close contacts should be evaluated for exposure. An SIR should be completed.

All medical staff should be able to identify these lesions. Students should be made aware of the importance of coming to the wellness center if they notice a skin lesion that does not heal.

Students should be reminded to practice good hygiene at all times, but especially if a MRSA outbreak is suspected on center. Remind students to:

• Not share washcloths, towels, or clothing
• Wash their hands regularly
• Wash their hands before they leave the recreation center and shower as soon as possible
• Keep any open sores covered with a dressing

In addition, students should be reminded to always take the full course of antibiotics as prescribed.

Basic precautions should be taken in the wellness center as well. If you think that a student may have MRSA skin infection, you should wear gloves during assessment and treatment.. All surfaces that could be contaminated should be wiped down with a commercial cleaner or a 1:100 bleach solution.

Although this strain of Staphyloccus is resistant to many antibiotics, often a higher dosage and longer duration are effective. Physicians should avoid beta-lactam antibiotics. Antibiotics such as doxycycline and trimethoprim-sulfamethoxazole may work. When an infection does not respond to a normal course of antibiotics, it warrants treatment beyond the scope of Job Corps and should be referred for emergency care. A severe MRSA infection is usually treated with intravenous vancomycin. In the case of a serious MRSA infection, an infectious disease specialist is often consulted and additional therapy is determined based on results of a culture and susceptibility testing.

Sources:

Chambers, HF. The changing epidemiology of Staphyloccus aureus? Emerging Infectious Diseases. 2001;7.

Department of Health and Human Services, Center for Disease Control and Prevention. Healthcare-Associated Methicillin Resistant Staphyloccus aureus (HA_MRSA).

Department of Health and Human Services, Center for Disease Control and Prevention. Methicillin Resistant Staphylococcus aureus (MRSA) Information for clinicians.

New York State Department of Health. Methicillin Resistant Staphylococcus Aureus (MRSA).

The University of Edinburgh, College of Medicine and Veterinary Medicine. MRSA.