Question

Thought and comments about this article

MRSA which is a gram positive bacterium and is concerned with skin and soft tissue infections, is one of the causes of community and hospital acquired serious infections. Community acquired MRSA (CA-MRSA) are distinct from hospital strains, infects and arises in young people of a community, those who are generally healthy and their healthcare do not receive in the hospital or on outpatient basis. Pimples and boils are the examples in this infection. On the contrary, healthcare acquired MRSA (HA-MRSA) refers to receiving hospital healthcare ("Community-Acquired and Healthcare-Associated MRS"). Mainly, infections due to the HA-MRSA arise in weakened and elderly patients. (Pressley, 2010. Pg. 645)

Hospital –acquired (HA) MRSA

HA-MRSA progresses outside the hospital while the patient is in the community and then receive treatment in the health care center .In the past there was an increase in strains of MRSA which was brought patients into the hospital. The strain was commonly known as Community Acquired MRSA. HA-MRSA are associated with patients who are in long-term hospitalization because of chronic condition of diseases such as diabetes, dialysis and ICU patients. One surprising thing is that a single patient never co-colonized with both HA-MRSA and CA-MRSA. (Pressley, 2010. pg. 645). Multidrug resistance is common in HA-MRSA, also the incidence as well as drug resistance in HA-MRSA are higher than that of the CA-MRSA. HA is more susceptible to trimethoprim-sulfamethoxazole but not to clindamycin. This is related to clinical syndromes which can be untreatable; therefore HA was a major cause of nosocomial pneumonia, catheter-related urinary tract, and blood-stream and skin infections. Typically any infection that happen in patient after 48 hours hospitalization or even within history of hospitalization, would be consider as HA. ("Comparative Analysis of Community Acquired and Hospital Acquired Methicillin Resistant Staphylococcus Aureus"). SCCmecA which is categorized into subtypes, for HA-MRSA it includes I- IV type. (Casey Schroeder, slide 30)

Community-Acquired (CA) MRSA

CA-MRSA was common in the public and can undoubtedly cause serious infections when the patient has primary disease. Even if these CA strains are obtained in a hospital from another patient, worker or a visitor, it still has its origin outside a medical center. It is mostly found in young patients such as athletes, prisoners, and soldiers, drug users, who live in crowded environments .Such people are at risk for CA-MRSA. In terms of antimicrobial resistance, beta-lactam resistance is common in CA-MRSA; moreover, the CA is susceptible to trimethoprim-sulfamethoxazole as well as clindamycin. Related to clinical syndrome, CA include post-influenza necrotic hemorrhagic pneumonia as well as skin infections. All infections that occur among the outpatients or inpatients earlier than 48 hours of hospitalization with MRSA isolate, would be recognized as CA-MRSA. ("Comparative Analysis of Community Acquired and Hospital Acquired Methicillin Resistant Staphylococcus Aureus"). The CA-MRSA strains, which are different from HA-MRSA, are similar to strains of methicillin-susceptible S. aureus (MSSA) not only in producing the Panton-Valentine leukocidin (PVL), a toxin that destroys the white blood cells and is a staphylococcal virulence factor that is produced by CA-MRSA infection and rarely can be find in healthcare-associated infections; but also characterizing Staphylococcal cassette chromosome mecIV (SCCmec IV), which explain the increased susceptibility to other antimicrobial agents. ("Community-Acquired and Healthcare-Associated MRS"). The staphylococcal cassette chromosome mec (SCCmec) type for CA-MRSA is IV and VII. (Casey Schroeder, slide 30)

Answer 1

Methicillin resistant staphylococcus aureus infection ia a dangerous condition because of the bacterium is resistant to most of the drugs and we cannot treat or control the infection by normal antibiotics. MRSA infections involve the skin or deeper areas of the body in the form of, for example, wound infections, lung inflammation or sepsis.

There are 2 type of MRSA community associated MRSA(CA-MRSA) or hospital associated MRSA(HA-MRSA).

HA-MRSA is the infectiondue to the recently been hospitalized or infection get from hospital environment. Community associated MRSA is infection from community. They can be treated with clindamycin (Cleocin), doxycycline (Adoxa, others), tigecycline (Tygacil), trimethoprim-sulfamethoxazole (Bactrim, TMP-SMX) and vancomycin (Vancocin).

There is also needed to isolate the patient to avoid spread. And also the health care providers should take necessary precusions to avoid the spread. The nurse patient ratio should be 1:1. This will prevent the spread of infection to other patients in the hospital. And also discard the waste from patient's room separately.