Microsoft word - background information on mrsa.doc

Background Information on Meticillin-Resistant Staphylococcus Aureus (MRSA)
How did MRSA develop?
Staphylococcus aureus was the commonest cause of wound infection and sepsis until the introduction of penicillin in 1940, but epidemic penicillin-resistant strains soon emerged and throughout the 1950s resistance to streptomycin, tetracycline, chloramphenicol and Penicillinase-resistant penicillins, such as meticillin, were introduced in 1960 but resistance to these developed within a year when the first case of MRSA was documented. Initially infections were severe, requiring treatment with vancomycin, but prevalence decreased in the 1970s; the reason for this is unclear. During the 1980s and 90s, epidemic strains of MRSA spread worldwide and MRSA became endemic in many UK hospitals. Considerable effort and focus - with reduction targets and national infection control initiatives - have helped to significantly reduce levels of infection in hospitals over the last ten or so years. What does MRSA cause?
Staphylococcus aureus (including those that are MRSA) causes anything from asymptomatic colonisation (where the bacteria are doing no harm but still capable of causing clinical infection) to a range of infections such as boils, carbuncles, infected wounds, deep abscesses and blood stream infections, which can be fatal. What do we mean by colonisation?
About 30% of the general population are colonised by S. aureus. In hospitals, S. aureus carriage is more likely to be MRSA, because antibiotic-resistant bacteria are selected out by the use of antibiotics to treat infection. Carriage sites are most commonly the nose and the skin, especially the axilla or groin. A carrier can be a source of infection for themselves if they have a wound. In high risk situations (e.g. patients for major surgery like a hip replacement or heart surgery) if pre-screening shows MRSA carriage, decontamination with skin and nose treatment is recommended before they are operated on. Wound infections
S. aureus / MRSA is the commonest cause of wound infection - either after accidental injury or surgery. This shows as a red, inflamed wound with yellow pus seeping from it. The wound may break open or fail to heal and a wound abscess could develop. Superficial ulcers
Pressure ulcers, varicose ulcers and diabetic ulcers (all due to poor blood supply and superficial skin damage) are often sites of MRSA infection. Intravenous line infections
MRSA may infect the entry site of an intravenous line causing local inflammation with pus from which the MRSA can enter the blood to cause a blood stream infection. Deep abscesses
If MRSA spreads from a local site into the blood stream it can lodge at various sites in the body (e.g. lungs, kidneys, bones, liver, spleen) and cause deep abscesses distant from the original site. These can be painful, with high fever and signs of inflammation near the infection. The patient will be very unwell and may have rigors (shivers), low blood pressure (shock) and possibly organ failure. This is usually linked with an associated septicaemia. Lung infections
MRSA is a rare cause of lung infection except in Intensive Care Units where ventilators bypass the defences of the nose and throat. MRSA can gain entry to the lungs via the tube Bacteraemia / septicaemia
MRSA can enter the normally sterile blood stream either from a local site of infection (wound, ulcer, abscess) or via an intravenous catheter. Bacteraemia describes the presence of MRSA in the blood. Septicaemia can follow and is the clinical term for a severe illness caused by the bacteria in the blood stream. The symptoms are not specific to MRSA and can be the same for other bacteria that cause septicaemia. Typically symptoms can include high fever, raised white cell count, rigors, disturbance of blood clotting with a tendency to bleed and failure of vital organs. This is the kind of MRSA infection that has the


Jcn332702 968.978

Clinical Outcome Measures in Spinal Muscular Atrophy Jacqueline Montes, Andrew M. Gordon, Shree Pandya, Darryl C. De Vivo and Petra Kaufmann 2009; 24; 968 originally published online Jun 9, 2009; The online version of this article can be found at: can be found at: Journal of Child Neurology Additional services and information f

Pearls #15 nov 04 nausea.doc

“Pearls”- Nausea in Palliative Medicine November 2004 1) Recognize : Nausea commonly exists without vomiting. Ask about appetite, response to the smell of food cooking, early satiation when eating. Nausea can interfere significantly with the joy of living and is important to recognize and treat. Nausea is so common with opiates that while vomiting may not be present, the atte

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