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 (MRSA) infection is caused by a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections so it becomes difficult to treat it. It is Mainly of two Types HA-MRSA ( Hospital Acquired) and CA-MRSA( Community Acquired) .

HA-MRSA infections occur in people who have Weak Immune System like who've been in hospitals or other health care settings, such as nursing homes and dialysis centers . When it occurs in these settings, it's known as health care-associated MRSA (HA-MRSA). It may even fluorish in patients taking medicines from hospitals to thier homes. HA-MRSA infections typically occurs after 48hrs of Hospital Infection. It is mainly seen in patients who are in long-term hospitalization because of chronic condition of diseases such as diabetes, dialysis and ICU patients.

Another type of MRSA infection has occurred in the wider community — among healthy people. This form, community-associated MRSA (CA-MRSA), often begins as a painful skin boil or a pimple to a Serious infection. It's spread by skin-to-skin contact. At-risk populations include groups such as athletes, prisoners, and soldiers, drug users, who live in crowded environments.

HA-MRSA strains have Become Multi-drug Resistance nowadays which is Still susceptible to Sulphamethoxazole-trimethoprim but not to Clindamycin whereas CA-MRSA is susceptible to both. The Increased Antibiotic Susceptibilty is attributed to various Toxins produced by CA-MRSA which can inhibited by these antibiotics.  

Various Steps can be taken by the patient's to save themselves from these Infections -

Preventing HA-MRSA

In the hospital, people who are infected or colonized with MRSA often are placed in contact precautions as a measure to prevent the spread of MRSA. Visitors and health care workers caring for people in isolation may be required to wear protective garments and must follow strict hand hygiene procedures.

Preventing CA-MRSA

• Wash your hands.
• Keep wounds covered
• Keep your personal items personal
• Sanitize linen
• Don't inject illicit Drugs.