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infection trajectory Methicillin-resistant Staphylococcus aureus (MRSA). The paper introduces the development of the bacterium in its most common iterations. The nature of the infection including symptoms, treatment options which are limited, and efforts from the health community are evaluated. Of particular importance is the portion concerning the differences between the communities-based version and the nosocomial version.
Introduction of Evolutionary History of MRSA
Nature of Infection
Diagnosis, Symptoms & Progression of an MRSA Infection
Rates of MRSA Infections in the U.S.A.
MRSA Treatment Strategies and Regimens: Prevention and Control
Economic Implications of MRSA Infections
Staphylococcus aureus is a bacterium. It usually lives on the skin and nose of human beings without leading to health problems. It becomes a problem when the bacterium causes an infection in the "skin, lungs, or blood" (Zeller 2011, p.1828). Methicillin-resistant Staphylococcus aureus (MRSA) is a staph infection which is resistant to the methicillin family of antibiotics including common ones such as penicillin (CDC, 2012). It is often identified as being among the leading causes of nosocomial (hospital acquired) infections (Enright, et. al, 2002). The National Healthcare Safety Report (NHSR) by the Centers for Disease Control (CDC) reports that the rates for nosocomial infections are falling. However, the MRSA infections continue to pose problems in communities where the rates of MRSA in the communities are rapidly increasing (CDC, NHSR, 2012).
This paper traces the history, development, current statistics, and treatment plans related with MRSA infections whether they occur in the health sector or at large in the wider community. In the first section the evolutionary history of MRSA is introduced. Sections II and III discuss the rates of infection in the U.S. And the symptoms and complications associated with MRSA infections. Section IV details the existing treatment plans for an individual with an infection. In section V, the ongoing efforts by epidemiologists, the CDC, and numerous health care professionals to decrease the rates of infection are discussed. Finally in section VI the economic implications of MRSA are explored.
I: Introduction of Evolutionary History of MRSA
In 1929 a scientist by the name of Fleming discovered penicillin, and it was immediately put to use in fighting Staphylococcus aureaus (SA) (Barnes & Sampson 2010. p.23). Within a decade resistant strain of SA began to emerge. Methicillin is an antibiotic; it was used to heal Staph infections which had become resistant to the other primary antibiotic of the times, penicillin (Enright 2002, p.7678). Within two years the first report that a strain of the Staphylococcus aureus had "acquired resistance to methicillin" was reported in England (Enright 2002, p. 7678). Soon thereafter similar strains of the MRSA were identified across Western Europe and in the United States Id. Of particular note, methicillin resistance was found in both the hospital version and the community based infection.
The prevalence and ubiquity of MRSA is now global: it poses a significant and often intractable problem for health professionals across the world. In their review of the development of MRSA isolates emergence in different countries, Enright et.al, reviewed bacteria samples collected over the course of 38 years and representing 20 nations to conduct their analysis. The worrisome part of their genetic explorations is the fact that many of the MRSA isolates are "only distantly related to each other, this poses significant problems for the treatment of MRSA (Enright, 2002, p.7689). In the United States the first reported incident of MRSA of the hospital variety occurred in 1968, the first community-based strain of MRSA in the U.S. was reported in 1980 (Huang, et. al, 2006, p. 2423).
It is important to note that part of the difficulty of treating and eliminating MRSA is the wide variety of strains which exist, the uncertainty of the relationship between the origins, and it's continually evolving nature. To this end the Enright study focused on the ancestral genotype origins of the most common strand including ST250-which is considered the "original MRSA clone" (Enright, 2002, p.7689). The ST250 is considered the original mutation which evolved with methicillin resistance; the data suggests that the mutations may have developed separately in other words the bacteria acquired methicillin gene while already possessing the staph infection ability Id p. 7691. The authors conclude that the gene which was resistant to methicillin was merely acquired by staph infections "that were already common with hospitals" (Enright 2002, p. 7692). The Enright study conclusions are troubling precisely because it suggests that the true locus of the problem is the staph infections already in hospitals which are in effect a ticking time bomb which can acquire resistance at random.
II: Nature of Infection
MRSA can spread to individuals' vis-a-vis touching one another's infected skin or by sharing personal objects or touching infected skin when touching objects (Zeller 2011, p. 1828). According to the CDC the rates of infection may be linked to the nature of the infection. There are 3 identified strains of community-based MRSA in the United States. The community-based MRSA is referred to as CA-MRSA as opposed to the nosocomial MRSA referred to as HA-MRSA (CDC, 2012). The biological differences between the two infections lie not in the location but rather in the spread and effect the CDC suggests that the CA-MRSA may spread easily and cause more skin infections than the hospital-based staph infection.
The majority of staph infections usually occur in soft tissue such as the chest arms and legs, studies such as those conducted by Huang find that between 55% and 61% occur in this region (Huang et. al, 2006, p. 2424). Community based infections of the CA-MRSA type was found in upwards of 45% of the population tested in Sacramento, California. While on the one hand CA-MRSA responds better to combinations of drugs it also has a high rate of resistant to several including erythromycin. The Huang, et.al, study was able to establish that "CA-MRSA is not a nosocomial strain which originated in local healthcare facilities (Huang et. al, 2006, p. 2426).
Other anomalies unique to the CA-MRSA version are the fact that there is a higher incidence among urban and poor communities, the authors in the Huang et. al, study attribute this to higher incidences of intravenous drug use (Huang et. al, 2006, p. 2426). Particularly concerning to the researchers was the notion that the community-based version and the nosocomial version might exchange genetic data (Huang et. al, 2006, p. 2426). In light of the fact that the CA version is particularly resistant the exchange would create a virulent version.
III: Diagnosis, Symptoms & Progression of an MRSA Infection
The severity of an infection will depend on whether an infection was received in a hospital setting or a community setting. The CDC notes that those infections which are nosocomial in nature are far more dangerous because they are usually related to surgical sites, may be infections of the blood, and as such the morbidity rate of HA-MRSA infections is higher while the prevalence of CA-MRSA infections is greater. The greater prevalence of CA_MRSA is compounded by the fact that those with CA-MRSA are diagnosed late because they do not have the usual risk factors. The risk factors for the hospital variation such as recent hospitalization, nursing home occupation, COPD illnesses or "other chronic…diseases which bring them into contact with health care settings" are absent in the community based infected population (Huang et. al, 2006, p. 2423). This makes the CA-MRSA diagnostic process more complex
There are certain populations who are especially vulnerable to the HA-MRSA infections including Native Americans, athletes, imprisoned individuals, children, and intravenous drug users (Huang et. al, 2006, p. 2423). In a study of 328 patients in Sacramento, California, Huang et al., reviewed and compared to the strains of MRSA. In the process the age, occupations, race, and insurance of patients were reviewed. Of significant note is that 67% of those with community based infections were unemployed compared to 29% in the HA-MRSA group. Though MRSA is associated with Methicillin resistance it is important to note that this means that it is a bacterium which also resistant to other frequently used antibiotics; this is the reason that infection is so difficult to treat (Zeller 2011).
Most MRSA infections appear as skin infection the CDC reports that they occur most often in the form "of pustules or boils which are red, swollen, or have pus and other drainage" (CDC 2012). Those individuals who have recently been in the hospital are athletic or work in the health profession will be diagnosed more quickly than those whose risk factors are not as obvious. The recent trend in testing all admitted patients for MRSA bodes well for identifying and diagnosing both the CA and HA versions. The difference between the two strains means that they display different antibiotic resistances.
Barnes & Sampson note that there are very few options for treatment, among them they state that some boils are treated with incisions and drainages with the application of heat to deal with abscesses (Barnes & Simpson 2010, p. 26). They…[continue]
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