A Report on the Problem of MRSA and the Resistance of S. Aureus to Penicillin-Based Antibiotics

Staphylococcus aureus (S. aureus) is a facultative anaerobe With a spherical shape that grows in clusters with a yellow appearance. This bacteria colonizes well in high moisture areas as well as light moisture environments, and can survive on dry surfaces for extended periods of time. In the majority of cases, this microorganism acts as a harmless commensal. However, in the right setting at the right time it can cause severe and at times fatal infections such as bloodstream infection (BSI). infective endocarditis.

pneumonia, skin and soft tissue infections (SSTI) and bone Infection. In this essay I will discuss the problem of MRSA which stands for meticillinrresistant Staphylococcus Aureus and refers to strains of S. aureus that have become resistant to penicillin-based antibiotics such as flucloxacrllin. ’ They are called methicillin-resistant because methicillin was the first member of this class of antibiotic however they are also resistant to antibiotics such as dicloxacillin, nafcillin, oxacillin as well as many cephalosporins lactam antibiotics, such as flucloxacillin were once the antibiotics of choice in treating staphylococcal infection, particularly methicillin throughout the 1950s and 19605.

However, by the year 1961, the first strain of methicillin-resistant Staphylococcus aureus (MRSA) was identified. This organism was also found to be resistant to all other Belactam antibiotics. Although methicillin IS no longer in clinical use all B-lactam-resistant S.aureus isolates are still referred to as MRSA. MRSA has been prevalent in Irish hospitals for over thirty years with significant accompanying mortality, morbidity and additional health care costs. Much work was carried out in this country on MRSA in the 19705 and “805 which has enhanced our understanding of the Virulence features, clinical effects and epidemiology of this pathogen.

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MRSA contains the mecA gene which is responsible for the production of an altered plasma membrane-bound enzyme, penicillin-binding protein 2a Penicillin-binding proteins are enzymes that participate in the production of a major component of the bacterial cell wall. The altered PBP 2a while able to perform its cell-wall synthesis function. does not bind to beta-lactam antibiotics.

Therefore. the presence of the mecA gene confers resistance to all beta-lactam antibiotics such as methicillin. The mec A gene along with several other antibiotic resistance genes is carried on the bacterium’s chromosome called the “staphylococcal cassette chromosome mec ” (SCCmec). Currently. there are 5 different types; I. II. III, IV, and V. and all of which vary in stze. The larger the SCCmec type. the more room there is for resistance and other genes. Hospitalracquired MRSA strains usually contain types I, II, or III, while community-associated MRSA strains contain types IV, and V.2 While anyone can carry MRSA, just like anyone can carry normal Staph. aureus, an MRSA infection is more common amongst patients in hospitals. This is because they are more likely to have an entry point for the bacteria to get into their body — e.g.. a surgical wound, an iv tube or a catheter.

People in hospital are also more likely to be elderly and to have a weakened immune system due to their illness/injury 7 putting them at higher risk of contracting an infection, MRSA — like any other bacteria — can easily be transferred from people’s hands directly to another person, or also indirectly via surfaces such as door handles, bed rails and linen. It can survive on objects like these, and without proper cleaning, can be picked up by another person a be it a doctor or a patient. Hospital staff attend to numerous different patients throughout the day, giVing plenty of opportunity for this cross-infection from one patient to another, The number of reported MSSA bloodstream infections in the Republic of Ireland increased from 820 in 2006 to 954 in 2009 but subsequently decreased to 818 in 2012. Between 2009 and 2012, the overall number of S. aureus bloodstream Infections has decreased by 19%. Although the overall trend in the proportion of MRSA observed in Ireland is decreasing it is still relatively high and compared with the UK and Southern European countries.

In 2012, Ireland ranked 9th out of 28 countries reporting to EARSrNet. Only six countries reported MRSA proportions greater than 25% and the lowest proportions are still seen in the Netherlands (<2%) and Nordic countries (s3%). 3 Globally. is has been found that the prevalence of MRSA infection varies from 5% to >50%, depending on the characteristics and size of the hospital. In Australia, 31.9% of the 2908 S aureus samples taken from 32 laboratories from all states and territories of the country were resistant to methiCillin.G The number of infections with MRSA in United States hospitals rose to nearly 369 000 in 2005.7 This increase has been noted in large tertiary-care teaching hospitals and small community hospitals. Multiple studies carried out in the United States and Europe have shown increased morbidity and mortality from MRSA infection compared With methiCiIIin-susceptible S aureus (MSSA) infection in critically ill patients. MRSA has been shown to prolong length of hospital stay. and to result in more adverse outcomes and higher costs. Treatment of MRSA infections will vary depending on the type and location of the infections.

Both community and health care assoCIated strains of MRSA still respond to certain antibiotics. In some cases. antibiotics may not be necessary. For example. doctors may choose to drain a superficial abscess caused by MRSA rather than treat the infection with drugs. More serious MRSA infections, especially HAVMRSA infections, are becoming increasingly difficult to treat. Antibiotics that may still work include; clindamycin, daptomycin, doxycycline. linezolid (Zyvox). minocycline. tetracycline. trimethoprim-suIfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS). and vancomycin (vancocin, vancoled). 9No matter what is prescribed it is important to finish all doses of antibiotics given, even if the patient feels better before the final dose. Stopping treatment early by not finishing the full course of antibiotics can lead to further drug re5istance in the bacteria, or can cause an infection to relapse.

Recent efforts to combat infections have focused on pharmaceutical interventions. However, in my opinion, the global spread of antimicrobial resistance calls for the reappraisal of personal and institutional hygiene. Hygiene embodies behavioural and procedural rules that prevent bacterial transmission. Consequently. the chance of spreading bacteria such as MRSA is significantly reduced. Hygiene is part of the primacy and totality of patient care, ensuring that no harm is done. Any prevention and control strategy must be underpinned by changes in attitude. embraced by all members of the healthcare team. The major components of preventing and controlling MRSA include hand and environmental hygiene (as part of standard precautions). patient isolation, and patient/staff decolonization. Improvmg hand hygiene practice is especially important where the risk of infection is highest, e.g. in intensive care.

Physical isolation also has its advantages: the physical barrier interrupts transmissmn, and this barrier emphaSises that precautions are required. With limited isolation facilities. risk assessment should be conducted to indicate which patients should be Isolated. When MRSA-positive staff are identified, restricting their professional activity will should also depend on the nature of their work. In December of last year, Health Minister James Reilly said measures, which include isolating patients infected with MRSA and making sure staff wash their hands, will help save lives and costs in the healthcare system, Dr Reilly said while rates of MRSA have halved since 2006, there is still along way to go. “We must continue to systematically address the prevalence of MRSA in Ireland,“ he said. “This guideline is a significant step.”

The guide Mr O’Reilly is referring to is called ‘Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA)’ which was backed by the National Clinical Effectiveness Committee (NCEC) and endorsed by the minister. It prowdes 53 practical recommendations on prevention and control measures for MRSA to improve patient care, minimise patient morbidity and mortality and to help contain healthcare costs. In conclusion. I believe that MRSA is not a problem that will simply disappear over the course of a few years. A worrying reality is that new treatments in the pipeline could take years if not decades to reach patients. In the meantime it will require patience, persistence and perspiration from patients scientists and healthcare professionals alike to prevent this problem from escalating to pandemic status within our hospitals.