MRSA Infections: Increasing Awareness About the Superbug

Ms. Terrie is a clinical pharmacy writerbased in Haymarket, Va

Reported outbreaks of methicillin-resistant Staphylococcusaureus (MRSA) infections, especiallyin schools, highlight the needfor greater public awarenessof how these types ofinfections are transmitted,treated, and prevented.

Transmission of MRSAis typically via direct skinto-skin contact or contactwith contaminated surfacesor items.¹ Many ofthe community-acquiredstaph infections have occurredamong athletes,who share equipmentor personal items, andamong children in daycarecenters.² Due tothese outbreaks, somedeaths have occurred andcaused significant publicconcern. Not all staphinfections are methicillin-resistant,however, andmortality rates associatedwith community-acquiredMRSA (CA-MRSA) infectionsare low.³

Awareness Key to Prevention

Increasing public awarenessof staph infections iscritical in order to decreasethe potential for additionalcases, as well as reducethe anxiety of individualsnot knowledgeable aboutthese infections. MRSAcan range from mild skininfections to more severe systemicinfections, and health care professionalsplay an essential role in patienthealth and safety. These professionalscan be instrumental in educatingpatients about staph infectionsby advocating proper infection controlmeasures, such as frequent handwashing. Many individuals underestimatethe value of hand washing indecreasing and preventing the transmissionof infections.

Results from a study published in theOctober 17, 2007, issue of the Journalof the American Medical Associationindicate that MRSA infections are consideredto be more prevalent than onceperceived. The Centers for DiseaseControl and Prevention(CDC) estimates that, in2005, approximately94,000individuals in the UnitedStates developed invasiveMRSA infections. Furthermore,an estimated 19,000deaths that year were theresult of MRSA infections,a mortality rate greaterthan that due to AIDS.^4-7 In addition, the studyreportedthat an estimated85% of all invasiveMRSA cases were associatedwith health care settings,whereas an estimated15% of infections werecommunity-related, whichmeans that these infectionsoccurred in individualswithout documentedhealth care risk factors.^4,5CA-MRSA has becomethe most prevalent causeof skin and soft tissueinfections among individualsvisiting the emergencyroom in the UnitedStates.^7,8 MRSA also cancause severe invasiveinfections.^7,8

The Pharmacist's Role

Pharmacists can helpdecrease the incidenceof antibiotic resistanceby utilizing their expertise to make clinical recommendations on appropriate antibioticuse, as well as being advocates for practicing infectioncontrol procedures, such as good hygiene and frequenthand washing. MRSA, like other superbugs, is the productof decades of excessive and unwarranted antibiotic use.⁸Leading causes of antibiotic resistance include inappropriateuse and overuse of antibiotics, as well as bacterial mutationand possibly the practice of adding antibiotics to agriculturalfeed.^9,10

As one of the most accessiblehealth care professionals, pharmacistsshould seize every possibleopportunity to counsel patients onthe proper use of prescribed antibiotics,explain the warning signs ofinfection, and provide informationon preventive measures for infectioncontrol. Patientsshowing anysigns of skin infections should beadvised to seek medical attentionimmediately.

The American PharmaceuticalAssociationhas issued recommendationsencouraging patients to confer withtheir health care providers about appropriate antibiotic useand infection control guidelines.¹¹ One of the greatest toolsin the fight against staph infections, particularly MRSA, isincreasing public awareness of the importance of infectioncontrol and effective means of preventing transmission.

References

• Questions and Answers about Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools. Centers for Disease Control Web site. www.cdc.gov/Features/MRSAinSchools/#q2. Accessed October 25, 2007.
• MRSA Infection. National Library of Medicine and National Institutes of Health Medline Plus Web site. www.nlm.nih.gov/medlineplus/ency/article/007261.htm. Accessed October 25, 2007.
• Johnson L and Saravolatz L. Community-acquired MRSA: current epidemiology and management issues. Medscape Web site. www.medscape.com/viewarticle/498770. Accessed October 23, 2007.
• CDC estimates 94,000 invasive drug-resistant staph infections occurred in the U.S. in 2005 [press release]. Centers for Disease Control Web site. www.cdc.gov/od/oc/media/pressrel/2007/r071016.htm. Accessed October 22, 2007.
• Drug-Resistant Staph a Widespread Threat. National Library of Medicine and National Institutes of Health Medline Plus Web site. www.nlm.nih.gov/medlineplus/news/fullstory_56237.html. Accessed October 25, 2007.
• Drug Resistant Staph Infections Reaching Epidemic Levels in Some Parts of the U.S. National Library of Medicine and National Institutes of Health Medline Plus Web site. www.nlm.nih.gov/medlineplus/news/fullstory_56428.html. Accessed October 24, 2007.
• Klevens, R, Morrison MA, Nadle J, et al. Invasive methicillin resistant staphylococcus aureus infections in the United States. JAMA. 2007;15:1763-1771.
• MRSA infection. Mayo Clinic Web site. www.mayoclinic.com/health/mrsa/DS00735/DSECTION=3. Accessed October 25, 2007.
• MRSA Infections. JAMA. 2007;15:1826.
• Antimicrobial Drug Resistance. National Institute of Allergy and Infectious Diseases Web site. www3.niaid.nih.gov/topics/AntimicrobialResistance/understanding/causes.htm.
• APhA Calls for Appropriate Use of Antibiotics - Pharmacists and Other Healthcare Professionals Can Educate the Public. Medical News Today Web site. www.medicalnewstoday.com/articles/85910.php. Accessed October 22, 2007.

For more information on MRSA, pleasevisit the following Web sites:

Centers for Disease Control andPrevention: Community-associatedMRSA Information for the Public:www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html

Centers for Disease Controland Prevention: Questions andAnswers about Methicillin-ResistantStaphylococcus aureus (MRSA) inSchools: www.cdc.gov/Features/MRSAinSchools/