OT: MRSA
- Thread starter sledog
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Yeah, it's bad. There are different types (i.e. blood, pneumonia, external) that are more dangerous than others. I've known people with pneumonia MRSA that were in ICU. Luckily they pulled through, but are now still on an oxygen tank.
I had external when I was rehabbing an injured leg in a nursing home. Nursing homes and hospitals run rampant with MRSA.
I was lucky it was external. They did some tests to find out which antibiotics would work best. I was on heavy antibiotics for a bit and it was scary. Luckily it was resolved with two treatments of the first antibiotics and didn't get worse. It's no joke.
I had external when I was rehabbing an injured leg in a nursing home. Nursing homes and hospitals run rampant with MRSA.
I was lucky it was external. They did some tests to find out which antibiotics would work best. I was on heavy antibiotics for a bit and it was scary. Luckily it was resolved with two treatments of the first antibiotics and didn't get worse. It's no joke.
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MRSA is methicillin-resistant Staphylococcus aureus (SA).
SA is one of the most common causative bacteria of lots of infections—skin, bone, bloodstream, pneumonia, prosthetic joint infections, etc. Huge burden of infections in both hospitalized patients with infections and in people with infections in communities & nursing homes.
It is a virulent pathogen with high mortality for the invasive infections.
The other problems with MRSA are:
-limited oral antibiotics with reliable activity. There are only really two cheap oral antibiotics (doxycycline and Bactrim) with fairly reliable activity (>80% chance of being active when you test it in the micro lab) that have fairly low adverse effects. The other two oral antibiotics (linezolid & delafloxacin) are very expensive and have some significant adverse effects.
-limited, but a bit more IV treatment options for MRSA. A lot of research into new anti-MRSA antibiotics hass resulted in some very useful options that we didn’t have ~10 years ago. Mainstay of therapy was and continues to be IV vancomycin, but there’s also drugs Iike daptomycin, linezolid, delafloxacin, ceftaroline & a couple others we can use if patients cannot tolerate vancomycin.
Lots of chronically ill folks become colonized with it and it’s tough to de-colonize.
At this point, ~50% of all SA infections in hospitalized patients will be caused by MRSA.
It has disseminated into the communities to the point that I see patients come to the hospital with MRSA infections who do not have obvious risk factors for it.
It’s kind of a big deal, you could say.
SA is one of the most common causative bacteria of lots of infections—skin, bone, bloodstream, pneumonia, prosthetic joint infections, etc. Huge burden of infections in both hospitalized patients with infections and in people with infections in communities & nursing homes.
It is a virulent pathogen with high mortality for the invasive infections.
The other problems with MRSA are:
-limited oral antibiotics with reliable activity. There are only really two cheap oral antibiotics (doxycycline and Bactrim) with fairly reliable activity (>80% chance of being active when you test it in the micro lab) that have fairly low adverse effects. The other two oral antibiotics (linezolid & delafloxacin) are very expensive and have some significant adverse effects.
-limited, but a bit more IV treatment options for MRSA. A lot of research into new anti-MRSA antibiotics hass resulted in some very useful options that we didn’t have ~10 years ago. Mainstay of therapy was and continues to be IV vancomycin, but there’s also drugs Iike daptomycin, linezolid, delafloxacin, ceftaroline & a couple others we can use if patients cannot tolerate vancomycin.
Lots of chronically ill folks become colonized with it and it’s tough to de-colonize.
At this point, ~50% of all SA infections in hospitalized patients will be caused by MRSA.
It has disseminated into the communities to the point that I see patients come to the hospital with MRSA infections who do not have obvious risk factors for it.
It’s kind of a big deal, you could say.
SA is an extremely common pathogen, and it's generally not that dangerous. Everyone is exposed to it; it's found on surfaces and dust in about 80% of homes, for example (Effect of home exposure to Staphylococcus aureus on asthma in adolescents). It's a common part of the skin microbiome. If you have open cuts or sores, it can enter the body easily and generate systemic infections. People with well functioning immune systems generally fight it off easily. The problem is that if you are sick and immune weakened, an infection may become severe. In that case you may need antibiotics to fight it off, but the antibiotics don't work against MRSA.
As with other infections, you get it by exposure. MRSA is most common in environments that use a lot of antibiotics or have a lot of sick people, such as hospitals.
As with other infections, you get it by exposure. MRSA is most common in environments that use a lot of antibiotics or have a lot of sick people, such as hospitals.
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A friend of my wife had a baby who was born prematurely but eventually got strong enough and she was able to take her home with a nurse coming to visit from time to time. After a few days the baby got sick and died. They determined it was MRSA which the nurse brought to their home from the hospital. Her marriage fell apart.
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It's actually more commonly what we call a hospital-acquired ("nosocomial" in fancy medical speak) infection, although it's super common in nursing homes as well where many residents are immunocompromised and surrounded by other sick people/potential MRSA carriers. It is resistant to a certain class of antibiotics called beta-lactams (penicillin is like the OG beta lactam), so we commonly use the drug vancomycin which has a different mechanism of action. Problem is, there are also vancomycin-resistant strains, so then we use other drugs like daptomycin or linezolid (especially for pneumonia). So, we do have drugs to treat it, but the problem it takes a while to culture bacteria from the blood, and in that time span we can't just give everyone daptomycin or linezolid or then THOSE will start to become ineffective.
The big problem/killer is that older and sicker patients are more prone to blood-stream infections, which can lead to sepsis. Sepsis is the big ultimate killer, and occurs when your immune system goes crazy trying to fight the infection, leading to the release of molecules called cytokines in the bloodstream. These cytokines cause your blood vessels to get very "leaky", so blood leaves the vessels and goes out into the tissue space. So now you effectively don't have enough blood flow to your organs, and then those organs start to fail, leading to death. Bad stuff.
The big problem/killer is that older and sicker patients are more prone to blood-stream infections, which can lead to sepsis. Sepsis is the big ultimate killer, and occurs when your immune system goes crazy trying to fight the infection, leading to the release of molecules called cytokines in the bloodstream. These cytokines cause your blood vessels to get very "leaky", so blood leaves the vessels and goes out into the tissue space. So now you effectively don't have enough blood flow to your organs, and then those organs start to fail, leading to death. Bad stuff.
Thanks. What I thought. I'm doing a hip replace next week. Heard a lot on how careful of infection you must be for hip replace. Anyhow, mysurgical pre-tests (nose swab) indicated I had MRSA. No idea how I got it. The surgeon, ENT, etc, think it's not serious, and will 'depopulate' the nose at pre-op. I think I'll visit an infectious disease specialist to be sure.
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