1. Holcomb, Susan ARNP, BC, PhD

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MRSA is the abbreviation for methicillin-resistant Staphylococcus aureus. Staphylococcus aureus, or staph for short, is found on the skin and nose of about one-third of people known to be carriers of MRSA.


In the 1990s, MRSA started to be seen in the community. It is called community-associated MRSA or CA-MRSA, and is a little different than the type seen in hospital settings (hospital-associated MRSA).


CA-MRSA's emergence into the community is primarily due to the overuse of antibiotics, such as when antibiotics are given for viral syndromes such as colds and flu. Usually, symptoms of a cold, such as sore throat, sinus headache, earache, and so forth, are treated inappropriately with an antibiotic. Antibiotics are also often contained in food and water sources, and are given to cattle, pigs, and chickens to prevent or treat infections before slaughter. When these animals urinate, the antibiotics are carried into our water supplies. Another source of resistance occurs over time when bacteria mutate in order to survive against antibiotics.


Who is at Risk?

CA-MRSA has been seen in all age groups; however, certain factors will make you more at risk for infection with CA-MRSA. Risk factors include: young adults and children, who tend to be more susceptible to CA-MRSA, whereas older adults are more susceptible to hospital-associated MRSA; students participating in contact sports; individuals with a weakened immune system; individuals living in crowded living situations; specific ethnic groups including Pacific Islanders, American Indians, and Alaskan Natives; and men who have sex with men.


In the early stages, skin infections due to CA-MRSA often start out as raised red bumps that are usually tender. In most cases, people think that the sore is caused by a spider bite, boil, or infected pimple. If left untreated, the sore enlarges, becomes deeper in red/purple color, is painful, may feel warm, and contains pus. An untreated sore can also begin to bore deeper and infect muscle, organs, joints, and other tissues.


What to Do

See your primary care provider (PCP). Do not pick at the sore-this will spread the infection. In order to obtain a culture, your PCP will perform an incision and drainage procedure. The procedure is not only diagnostic, but is also considered treatment as it relieves the sore of pus and MRSA bacteria. Once completed, an antibiotic cream or ointment may be applied and a dressing may be placed on the sore.


Your PCP may prescribe an antibiotic known to work against CA-MRSA while awaiting results of the culture. A sulfa-based antibiotic is commonly used. If you are allergic to sulfa, then an antibiotic such as clindamycin may be ordered. You must take the antibiotic as directed until it is finished, as well as follow up with your provider as directed.


Home Treatment

Take your antibiotic as ordered even if your sore disappears or does not hurt any more. Your PCP may also have you do warm soaks to help draw out the pus from the sore. If your sore was opened through incision and drainage, be sure to change the dressing as ordered or when it becomes wet with fluid or pus.


In order to prevent the spread of CA-MRSA to other parts of your body or to someone else, you should:


* Wash you hands both before and after the dressing change.


* Remove the dirty dressing with gloves and dispose of it into a container immediately where no one else can get access to the dressing.


* Clean the sore as directed by your PCP using disposable materials or a wash cloth that will immediately go into the wash. Do not reuse dressing and cleaning supplies.


* Dispose of your gloves as you did the dressing.


* Disinfect any counter space or other equipment you used with a household disinfectant.


* Wash clothing and cleaning materials contaminated with MRSA separately and with hot water and bleach (if possible), and dry on the warm or hot settings in your clothes dryer.


* Shower daily. You may be asked to shower with an antibacterial soap while you have the infection.


* Change your clothes daily and do not wear them again before they have been washed.


* Wash bedding and towels that were not used to clean your sore at least once a week.



Prevention Tips

The best prevention of CA-MRSA is hygiene. Daily cleanliness and health practices will best help reduce your chance of becoming infected with CA-MRSA. Other tips include the following:


* Do not ask for an antibiotic for colds, sore throats, or the flu. Make sure your PCP has determined that you need an antibiotic. If you are prescribed an antibiotic, take the full course as directed.


* Wash your hands frequently and at least for 15 to 30 seconds. Use hand sanitizer when water and soap are not available.


* Do not share personal care equipment such as make-up, razors, hair care products, and so forth.


* Keep any sores that are open and draining covered to prevent spread of infection from you to somewhere else on your body or to someone else.


* Shower as soon as possible after exercising and do not share towels. Wash gym and exercise clothing after each use. You should not be involved in contact sports or other contact activities until your sore is healed. Also, you should not share equipment that could touch your sore.


* Keep your sore bandaged and covered.



Stop Recurrence

If CA-MRSA symptoms recur, ask your PCP to help you determine what risk factors or other variables are the cause. Your provider may want to swab the nose of each of your family members or others who are living with you to see if they are carriers of MRSA. If you and your provider cannot get to the root of your continued infections, then you may have to see an infectious disease specialist.


Did you know?

When you get a skin infection from a cut or wound, staph is commonly the organism for which your healthcare provider gives you an antibiotic to treat.


Did you know?

The enlargement and extension of a sore is called an abscess. If an abscess forms, you may develop flu-like symptoms and experience fatigue, fever, body aches, and swollen lymph glands.


Susan Holcomb, ARNP, BC, PhD