Methicillin-resistant

Staphylococcus aureus

Kiana Cabbat
Giselle Franklin
Jesse Mendoza
Dyrell Sakamoto
 What is MRSA?
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria
that is resistant to certain antibiotics called beta-lactams.

These antibiotics include methicillin and other more common antibiotics such
as oxacillin, penicillin, and amoxicillin.

In the community, most MRSA infections are skin infections. More severe or
potentially life-threatening MRSA infections occur most frequently among
patients in healthcare settings.

Leading drug-resistant pathogen in our nations hospitals (CDC, 2016).

MRSA: a Gram-positive bacterium

 Vancomycin-intermediate
Staphylococcus aureus
also called VRE, VISA and VRSA

Specific types of antimicrobial-resistant bacteria

As of October 2010, all VISA and VRSA isolates have been

susceptible to other Food and Drug Administration (FDA)-approved
drugs.

Persons who develop this type of staph infection may have

underlying health conditions (such as diabetes and kidney disease),
tubes going into their bodies (such as catheters), previous
infections with methicillin-resistant Staphylococcus aureus (MRSA),
and recent exposure to vancomycin and other antimicrobial agents.
 Classification

The Latin translation of Staphylococcus aureus is golden cluster seed, this baterium
was aptly named because of its yellow color and the fact that this organism grows in
multiple clusters

Taxonomy Name Reason placed in specific taxonomy

Domain: Bacteria Very small, single-celled, reproduce quickly

Kingdom: Eubacteria Commonly occurring prokaryotes

Phylum: Firmicutes Firmicutes are gram-positive

Class: Baccilli Bacilli generally are rod-shaped, but not all

Order: Bacillales

Family: Staphylococcaceae Medically significant pathogens in this family

Genus: Staphylococcus Divide into two planes

Species: Staphylococcus aureus Yellow coloring

Subspecies: Methicillin-resistant S. aureus Resistant to methicillin an antibiotic

Dangerous
Beauty
 Discovery

The Scottish surgeon Alexander Ogston (1844-1929) is credited with discovering the major cause
of pus present in Staphylococcus aureus infections in the year 1880. Dr Ogston was significantly
troubled by the high rate of post-operative mortality and sought to reverse this tragic trend as well
as identifying the cause. Dr. Ogston studied the absence of inflammation, a sign of infection, in
Dr. Joseph Lister's (1827-1912) post-operative surgical sights and adopted his antiiseptis practices
(practices preventing the growth of disease-causing microrganisms). He did this in direct
contradiction to the contemporary teachings of his day, in which suppuration (outpouring of pus
from a wound) was regarded as a required stage of healing.

After examination under the microscrope My delight may be conceived when there were
revealed to me beautiful tangles, tufts and chains of round organisms in great numbers, which
stood out clear and distinct among the pus cells and debris...
Adaptations of Staphylococcus aureus

In 1928 Penicillin was discovered by chance, Bacteriologist

Alexander Fleming noticed that mold was growing on one of his
bacteria experiments. Most importantly, at the edge of the mold
the bacteria in the Petri dish had been destroyed, the bacteria
was Staphylococcus aureus. Eventually doctors gave Penicillin
to their patients in order to kill Staph infections, this meant most
Staph infections were largely no longer fatal.

By about 1959, 90-95% of Staphylococcus aureus infections were

resistant to Penicillin. This new strain was resistant due
penicillinase, an enzyme, which lysed the penicillin protecting
the bacteria against this drug.

This is possible because bacteria is highly adaptable to its

environment. Accomplishing this feat by possessing a mutation,
which increases the bacteria's ability to survive in the presence of
antibiotics. Mutations can be enzymes, some eliminate the site
where antibiotics invade the cell, yet others allow the bacteria to
expel antibiotics prior to damaging the bacteria.
Notice the "halo" , which is free of bateria S. aureus
surrounding the Penicillium chrysogenes
Resistance
Drugs and Resistance
With penicillin rendered impotent against the threat of Staph, new drugs were
required, this drug was methicillin.

Resistant to all -lactam agents, including cephalosporins and carbapenems,

although they may be susceptible to the newest class of MRSA-active
cephalosporins (e.g, ceftaroline).

Within one year of using this new drug, the first case of MRSA was reported.
Methicillin became resistant due to a "penicillin-binding protein that is coded
by the methicillin resistant gene also known as mecA, (mecA is responsible for
resistance to other -lactam antibiotics). Additionally, MRSA is able to evade
attacks by antimicrobial peptides (AMPs) and other parts of the hosts innate
defense (Li, 2007)".

Antimicrobial resistance of Methicillin-resistant Staphylococcus aureus has

increased significantly over the past two decades. The medical community has
generally turned to the use of the antibiotic vancomycin as a substitute for
methicillin.
I

MRSA/VRE MEDICATIONS AND SIDE EFFECTS

TOPICAL MEDICATIONS
Clindamycindiarrhea promote c. difficile

Linezolid (Zyvox, Zyvoxid or Zyvoxam)diarrhea, bone marrow suppression, low

platelet count, neuropathy)

Mupirocin (Bactroban)HA-NV, Secondary wound infection

Trimethoprim-Salfamethoxazole (Septra or Bactrim)Not recommended for 3rd

trimester pregnancy, severe liver damage and acute renal failure

Tetracyclines ( Doxycycline and Minocycline)..not recommended for 8 years and

younger, yellowing of eyes, skin and teeth

INTERNAL TREATMENT IV OR ORAL (Severe)

Vancomycin (IV)Ringing ears, impaired kidney function

Linezolic (Oral or IV)skin infections

Daptomycin (IV)Bloating, rapid weight-gain, tingling extremities

Clindamycin (Oral or IV)..N/V, diarrhea, dizziness

How should clinical laboratories test for MRSA/VRE?

Culture must be obtained

Small biopsy of skin

Drainage from infected site

Blood Sample

Urine Sample

Sent to microbiology laboratory

Test for S. aureus infection

Determine which antibiotic will be effective

 Infection vs
Colonization
Infection - when germs are present and causes sickness,
which results in symptoms of a fever or weakness.

Colonization - when germs are present, but DO NOT

AUTOMATICALLY cause sickness.
 MRSA Colonization
S. aureus is an extremely adaptable bacteria and therefore
able to survive on our skin by attaching itself to receptors on
the epithelial cell layer at the skins surface. MRSA/S. aureus
is particularly good at competing for these limited binding
spaces.

A persons genetics are now thought to predispose some

people to a higher rate of S. aureus , which is representative in
the fact that roughly 30-40% of humans are permanently
colonized with S. aureus. Those with lower rates of the
bacteria present on their epithelium are either transient or
non-carriers.

The nasal passages are usually the site with the highest rate of
colonization. It is important to note that characteristics and
rates of permanent MRSA/S. aureus can vary considerably
based upon the individual sites such as the throat, armpits,
groin and perineum. In fact colonization in one part of the
body does not guarantee colonization in another.

Clinicians and scientists now know how essential testing

multiple sites is, due to the fact that a direct corollary between
colonization and successive infections exists.
MRSA FDA Approved Drugs

THE LIST:
quinupristin/dalfopristin
(Synercid, King Pharms)
linezolid
(Zyvox, Pharmacia and Upjohn);
daptomycin
(Cubicin, Cubist);
tigecycline
(Tygacil, Wyeth Pharms);
telavancin
(Vibativ, Theravance)
AND the newest
ceftaroline
(Teflaro, Cerexa)
 VANCOMYCIN DOSING

Vancomycin dosing is based on the patients actual body weight and requires
adjustment in renal dysfunction.
* round dose to 250mg, 500mg, 750mg, 1g, 1.25g, 1.5g, 1.75g or 2g (maximum:
2gm/dose).

Higher total daily doses of vancomycin have been associated with

nephrotoxicity (toxic to the kidneys).

For patients with uncomplicated infections requiring vancomycin, trough

levels of 10-15 mcg/ml are recommended.
For patients with serious infections due to MRSA (central nervous system
infections, endocarditis, ventilator-associated pneumonia, bacteremia or
osteomyelitis) , trough levels of 15-20 mcg/ml are recommended.
ID CONSULT IS RECOMMENDED.
 Vancomycin Mechanism of Action and Resistance

Mechanism of vancomycin action and resistance. Note that this diagram shows only one of two ways vancomycin
acts against bacteria (inhibition of cell wall cross-linking) and only one of many ways that bacteria can become
resistant to it.
1. Vancomycin is added to the bacterial environment while it is trying to synthesize new cell wall. Here, the cell
wall strands have been synthesized, but not yet cross-linked.
2. Vancomycin recognizes and binds to the two D-ala residues on the end of the peptide chains. However, in
resistant bacteria, the last D-ala residue has been replaced by a D-lactate, so vancomycin cannot bind.
3. In resistant bacteria, cross-links are successfully formed. However, in the non-resistant bacteria, the
vancomycin bound to the peptide chains prevents them from interacting properly with the cell wall cross-
linking enzyme.
4. In the resistant bacteria, stable cross links are formed. In the sensitive bacteria, cross-links cannot be formed
and the cell wall falls apart.
 Alternative Therapies
Alternate Treatment
FOOD

GARLIC: You can cure and prevent MRSA by eating garlic, according to Dr. Ron Cutler, a
researcher at the Department of Medical Microbiology, University of East London. Dr. Cutler,
an expert on MRSA, reports that the allicin in garlic kills established MRSA, along with the new
varieties of the superbug. Eat one or two garlic cloves a day, either raw or added to your food.
As a topical application, apply mashed garlic clove on the boil and cover with a bandage for 24
hours, until you change the bandage again. Keep mashed garlic on the boil until the boil heals.
TUMERIC: According to a study from the Institute of Hepatology, University College London
Medical School, London, the curcumin in turmeric may fight inflammation and increase
resistance to disease. Other research suggests that turmeric may suppress the host gene that
binds to bacteria, thereby preventing bacteria from invading host cells. Make an oral turmeric
remedy. Combine 1 tsp. of turmeric powder in 2 cups of warm water and drink three times a
day, for current staph infections, and up to two weeks after the boil heals. If you have
recurrent episodes of MRSA boils, drink the turmeric remedy twice a day to keep blood clean.

METAL

COLLOIDAL SILVER: Colloidal silver is microscopic particles of silver that are held in a liquid
suspension. Prior to the invention of antibiotic drugs, silver was widely used by physicians as
a mainstream antibiotic because of its germicidal properties. Colloidal silver is usually
available as liquids and creams. Many colloidal silver products with varying degrees of
germicidal activity are available and not all colloidal silver products are created equal. Factors
including silver production and silver ion size contribute to the effectiveness or lack of in the
product. CAUTION: A very rare medical condition called Argyria which causes irreversible
gray skin coloration can occur if large quantities of improperly prepared silver accumulates in
the body

LIGHT THERAPY

LED: Blue Light Therapy has been reported to help topically treat MRSA infections. In 2009,
Enwemeka and colleagues concluded that relatively low doses of blue light using an LED device
that emits blue light--about 100 seconds worth--killed off about 30 percent of MRSA in vitro.
Longer doses were more effective, 10 times the exposure length to eliminate 80 percent of the
MRSA in culture dishes. Blue light has already received FDA approval for use as an antibiotic in
some areas, such as in the mouth and with acne.
 How is it transmitted?
MRSA flourishes on human
skin and can travel from
person to person by direct
contact between broken and
infected skin, mucus or germs
spread by sneezes or coughs
Indirect contact includes
handling contaminated
objects such as clothing,
bedding, towels, furniture or
equipment found in hospitals
or gyms
Can also be obtained through
contact with polluted waters
Spread of MRSA and VRE in Healthcare
Facilities
Antibiotics
Wounds or invasive medical devices such as catheters are more
likely to get an infection
Indwelling urinary catheters, vascular access devices, endotracheal
tubes
Treated in the same room as or close to another patient with
MRSA
Unclean hands or medical equipment
unclean hands of healthcare workers or visitors, MRSA can be
spread when patients contact contaminated bed linens, bed rails,
and medical equipment.

What Are Some of the Things that Healthcare

Facilities are Doing to Prevent MRSA
Infections?
Clean hands with soap and water or an alcohol-based hand
sanitizer before and after caring for every patient
Clean hospital rooms and medical equipment
PPE: Gloves and put on gloves and wear a gown over their clothing
while taking care of patients with MRSA.
 Signs & Symptoms
Begins as little red bumps,
similar in appearance to
pimples

Wound site may present

symptoms such as erythema,
edema, heat, puss

Accompanied by painful
sensitivity
 MRSA IDENTIFICATION
Many skin
infections are
similar in
appearance

A quick trip to the

doctor is always
recommended for
proper disease
diagnosis
Who's at Risk?
Athletes

School children

Homeless people

Hospital patients

Individuals with weak

immune systems

Military personnel

People constantly exposed

to large groups
 Prevention

Wash hands with soap and water Use an alcohol-based hand

frequently sanitizer Keep wounds covered with fresh
bandages and avoid touching
others wounds or bandages

Shower/bathe daily Wipe down gym equipment

Change in to fresh before and after each usage
clothing regularly
 Treatment
MRSA does not always require
hospitalization

Drug therapies and wound care are

performed

Medicines such as Linezolid,

Vancomycin and Daptomycin can kill
active or potential infections

For more common skin infections,

incision and drainage of the wound
with an antibiotic treatment is
practiced

However, early detection with a visit

to your doctor is crucial in obtaining
the correct medications and treatment
Stop the spread of
Dont share personal
items such as
hairbrushes, towels,
razors or syringes
How does MRSA affect Hawaii Residents?

Native Hawaiians are at a higher risk of

getting staph infections

Hawaii has twice the national average in

MRSA outbreaks and MRSA related hospital
visits

The Center for Disease Control and

Prevention (CDC) found a continued
increase in the number of Hawaii residents
admitted to hospitals for MRSA
 Post Test
What is the most effective way to stop the spread of
MRSA? handwashing

True or False: You must wear gloves and a gown

before entering patients room with MRSA?
True

Is MRSA gram a gram negative bacterium?

No. it is a gram positive bacterium
 October 2, 2017 is World MRSA day
Educate yourself & don't let this harmful disease
invade your community!
Frequently Asked Questions (FAQ)
1.) What is MRSA?
MRSA stands for methicillin-resistant Staphylococcus aureus. It is a type of staph bacteria that is
resistant
to certain antibiotics, making it more difficult to treat. This staph bacteria often lives in the nose and
on
the skin, which has the potential of causing an infection.
2.) How common is it?
Approximately 30% of the worlds population is colonized with staph bacteria and about 1% with
MRSA. Current estimates imply that one out of every 100 people in the U.S. are colonized with MRSA.
Hawaii has twice the national average in MRSA outbreaks and hospital related visits.

3.) What is the difference between infection and colonization?

Infection - presence of bacteria with signs of illness or inflammation (e.g. pain or redness).
Colonization - presence of bacteria, but no signs of illness or infection.

4.) Who gets it and how does it spread?

Anybody can get MRSA, but MRSA infections are far more common among patients in hospitals and
healthcare facilities. Others at risk include: prisoners, athletes, homeless people and military personnel.

MRSA can be spread among people having close contact with colonized or infected people. It can also
be obtained by sharing or using contaminated items (e.g. razors, towels or gym equipment).

5.) What are its symptoms?

MRSA most often appears as a skin infection, like a pimple or boil. Symptoms of infection include:
redness, inflammation, presence of puss and painful sensitivity.
 FAQ continued
6.) How is it treated?
Medicines like Vancomycin are available to kill active or potential infections. Drug therapies and
wound care are often performed. However, incision and drainage of the wound with an antibiotic is
highly recommended. A hospital visit isnt always necessary, but a visit with your healthcare provider
is definitely helpful in early detection and correct treatment procedures.

7.) What can be done to prevent it?

The simplest way to avoid MRSA infections is to practice good hygiene:
Wash your hands thoroughly with soap and water.
Keep cuts and wounds clean and covered with proper bandages until healed.
Avoid touching other people's wounds or bandages.
Avoid sharing athletic equipment, towels, razors, etc.

8.) What should I do if I think Im infected?

See your healthcare provider. In the meantime, keep any wounds covered with a clean bandage
and wash your hands frequently to avoid spreading germs to those in your household.

9.) If Im infected, is it okay to attend work or school?

People with MRSA should always seek medical treatment and follow the recommendations of their
healthcare professional about returning to work or school. In general, people with MRSA can continue to

work and go to school if they keep their wounds covered, practice good hygiene and avoid activities in
which skin-to-skin contact may occur.
10.) Could an infection come back after its treated?
It is possible to have a MRSA skin infection come back after its treated. To prevent this from happening,
follow your healthcare providers directions while you have the infection and follow the prevention steps
after the infection is gone.
 References
Retrieved
Frequently Asked Questions About MRSA. (2005, August).
from
http://www.state.nj.us/health/cd/mrsa/documents/mrsa_faq.pdf

http://www.oregon.gov/DHS/ph/acd/diseases/mrsa/facts.shtml
MRSA FAQ. (2005, April 21). Retrieved from

http://www.mountcarmelhealth.com/education-support/mrsa-faq/
MRSA FAQ. (n.d.). Retrieved from

http://www.mayoclinic.com/health/mrsa/DS00735/DSECTION=test
MRSA Infection. (2010, May 29). Retrieved from
s-and-diagnosis

Retrieved
MRSA Slideshow: A Closer Look at MRSA. (2010, February 25).
from http://www.webmd.com/skin-problems-and-
treatments/slideshow-closer-look-at-mrsa

from
Understanding MRSA Symptoms. (2009, December 5). Retrieved
http://www.webmd.com/skin-problems-and-
treatments/understanding-mrsa-symptoms

(Harvard Women's Health, 2008)