Does that red, painful boil on your arm worry you? It should – it could be a potentially life-threatening MRSA infection.
In this exclusive interview, a top infectious-disease doctor reveals what you need to know about the scary antibiotic-resistant bacteria...The nation’s No. 1 health threat is antibiotic resistance, the Centers for Disease Control and Prevention (CDC) warns in a 2014 report.Germs that shrug off antibiotic drugs lurk in locker rooms, hospitals, playgrounds and dormitories. They cause 2 million infections and kill at least 23,000 Americans each year, according to the CDC.Among the most worrisome of these bugs is methicillin-resistant Staphylococcus aureus, commonly known as MRSA. It’s an infection caused by a staph bacterium, but it resists the medications usually used to treat ordinary staph infections.MRSA has been around since the 1960s, when it was found in hospitals and nursing homes. But in the late 1990s, a second type of MRSA infection was identified, mostly among children and adults who had no existing medical conditions.A MRSA infection is easy to catch, and that has health experts worried.
“MRSA is a serious threat,” says Rekha Murthy, M.D., medical director of the Epidemiology Department at Cedars-Sinai Medical Center in Los Angeles. “If you get an infection from bacteria that are resistant to all antibiotics, you may be out of luck.”That’s because MRSA patients are susceptible to sepsis, a life-threatening infection in the blood that worsens quickly. It causes high fever, kidney and liver shutdown, difficulty breathing and rapid heartbeat.Who’s most at risk for a MRSA infection, how do you know if you have one, and how can you prevent it? Here, Dr. Murthy answers your most pressing questions about this medical threat.How do the two types of MRSA infections differ?
The most common is known as Health-care associated MRSA (HA-MRSA). It was – and to a lesser extent today still is – a major problem in hospitals and nursing homes, where patients with weakened immune systems are susceptible to the infection.
In hospitals, patients get it from intravenous lines and surgeries, when they’re hooked up to machinery such as a ventilator and when they’re exposed to hospital workers who carry the bacteria.[Editor’s note: This MRSA strain can cause life-threatening bloodstream infections and pneumonia.]Community-acquired MRSA (CA-MRSA) emerged about 15 years ago in people who had no contact with health-care facilities. Unlike the hospital-acquired strain, which is resistant to many antibiotics, CA-MRSA is easier to treat.Anyone can get this type – you don’t have to have other health conditions. It spreads through cuts and skin-to-skin contact and can cause pneumonia and severe skin infections.How do people get MRSA infections?
You can get HA-MRSA from contact with contaminated items in a hospital – bed linens, bedrails, bathroom faucets and medical equipment.[Editor’s note: You can also get it from a doctor’s or nurse’s hands or from hospital visitors.]
CA-MRSA can spread in [gym locker rooms], dormitories or jails. It’s linked to sharing towels and razors and poor hygiene practices.Think about athletes with scrapes, cuts and infected wounds using the same towels. The bacteria can get into wounds that way.You get it most commonly from touching someone with an infected wound, [after which] you don’t wash your hands. Or it’s spread through touching contaminated surfaces [when you have] an open wound.Can a pregnant woman with a MRSA infection transmit it to her baby?
Yes, if it’s the CA type. It’s uncommon, but women with boils on their thighs have transmitted skin infections to their babies when they delivered vaginally.If you have a skin infection, speak to your doctor and make sure you’ve addressed the problem before delivery.Again, it comes down to good hygiene: Make sure you wear a hospital gown, practice good hand hygiene and cover the areas your infant may be exposed to.
How do you know when you have a MRSA infection?
If you have a preexisting scrape, it gets red, swollen and painful. Most of those infections don’t need to be treated with antibiotics; you can just put a hot compress on the area and it will clear up pretty quickly.If you have no preexisting cut, the infection looks like a pimple, abscess or boil – there’s redness, swelling, pain and pus. You know something is wrong.If you get a fever or the infection gets worse, your doctor will take a sample for a culture [laboratory test] and give you an antibiotic to protect you until you get the results. Don’t drain the boil yourself – you can make it worse.How dangerous are MRSA infections?
MRSA infections can rapidly progress, over hours or a day. When you see the first signs of it – you develop a fever above 101.3, your heart rate is faster than 90 beats per minute, you feel disoriented – see a doctor.What happens if the infection spreads?
If it gets into the bloodstream, you experience a cascade of reactions that causes your body to fight so hard that it damages organs.Sepsis [blood poisoning] can injure your body’s soft tissues, such as your muscles, far from the original infection site.
It can also make your kidneys shut down. That doesn’t always happen, but there’s a higher risk if you have an immune-compromised condition.[Editor’s note: Immune-compromised conditions that increase risk include HIV/AIDS, type 1 diabetes and rheumatoid arthritis.]In rare cases, the sepsis can cause death.Even after the infection is under control, you may have an abscess that must be surgically drained.Can you have MRSA and not know it?
Yes – 2 out of 100 people are MRSA carriers, or “colonizers.” You have [MRSA] in your nose or on your skin, even though you have no visible symptoms.Are all types of staph harmful?
No. Up to 30% of healthy, normal people have staph bacteria in their nose or on their skin. They’re typical, nonthreatening bacteria.Remember that Staph aureus bacteria have been around for a long time. Penicillin was developed [in the 1930s in England] to combat infections from that bacteria. But soon after it came out, some bacteria were found resistant to penicillin. That problem is more troublesome today.
Why?
More and more, bacteria can resist the effects of antibiotics because some people take the [medications] too often and when they’re not needed.The bacteria change and drugs can no longer cure infections. [Editor’s note: The bacteria evolve and multiply, spreading to family members and the community, according to the CDC. Antibiotic-resistant bacteria are especially dangerous to children and the elderly.]Who’s most at risk for a MRSA infection?
Generally, people who are in a hospital or other health-care setting and have other health conditions that make them sick – for example, they’re hooked up to an IV, are using a ventilator or urinary catheter, or have had surgery – are at highest risk for HA-MRSA.You’re at higher risk for CA-MRSA if you participate in contact sports or are in the military. Men having sex with men also are at higher risk.If you get a cut, make sure to clean your skin to prevent infection; the bacteria from your skin can get into the wound. Just having these bacteria on your skin or in your nose increases your risk for getting an infection.
Should we be afraid of getting MRSA?
Not really. It mostly affects people who are really sick and getting lots of health care.[Editor’s note: Because of greater attention paid to staph infection prevention, hand hygiene and hospital safety improvements, overall rates of MRSA dropped 31% between 2005 and 2011, according to the Center for Disease Dynamics, Economics & Policy. The largest declines (54%) were among infections occurring during hospitalizations. But the problem is still widespread in other health-care settings.]How is the infection treated, when it’s resistant to so many antibiotics?
First, doctors seek the source of the infection; we find out where the problem has started – an abscess, for example.We get an X-ray or blood culture to make sure it hasn’t spread beyond that wound. Then we decide if you need antibiotic treatment – if it’s a small boil, you may not. We make sure the infected area is clean.MRSA is resistant to some antibiotics [such as erythromycin, clindamycin, fluoroquinolones and rifampin]. Vancomycin is the drug of choice for most MRSA infections, especially if the patient has a life-threatening one, [because the bacteria haven’t built up as much resistance to it].
How can people prevent MRSA infections?
These are my top tips:
- Do what your mom taught you – practice good hygiene! Wash your hands often with soap and water, and avoid sharing towels or clothing that’s been in contact with an infection.
- Clean and bandage your cuts.
- If you’re in the hospital, make sure the people taking care of you are washing their hands and using gloves when touching you.
- Avoid contact with people with skin infections.
- Don’t take antibiotics if you don’t need them – when you have a cold, for example, which is a viral infection, not bacterial. If you have to take antibiotics, do so as prescribed – if it’s for 10 days, don’t stop after 3. If you [don’t take the full course of medication], you’re giving antibiotic-resistant bacteria the opportunity to multiply and take hold in your body.
- Check your pets – they can catch and transmit skin infections.
To learn more about staying healthy in the hospital, read Preventing a Hospital Infection and Other Mishaps.