Community-Associated Methicillin Resistant Staphylococcus aureus
Recently, cases of skin infections caused by Methicillin-Resistant Staphylococcus aureus (MRSA) have been identified in the community. While most cases have involved athletes, cases involving non-athletes have also occurred. Skin infections such as abscesses and boils are the most common form of this infection. The infected area usually starts out as a small bump resembling a pimple or spider bite, which becomes redder and often develops pus drainage. The information below provides some general information about these types of infections and what people can do to help prevent and control the spread of MRSA in the community setting. Copies of the video "Prevention of MRSA in the Athletic Setting" are being offered for sale. Order a copy.
Frequently Asked Questions
What is MRSA?
MRSA is a type of infection caused by the bacteria Staphylococcus aureus (or S. aureus). Staphylococcus aureus, often referred to simply as " Staph," are bacteria commonly carried on the skin or in the nose of healthy people. Some strains of S. aureus are resistant to a class of antibiotics frequently used to treat Staph infections such as methicillin (which is a synthetic form of penicillin)—and thus are called Methicillin-Resistant Staph aureus (or MRSA).
Who gets MRSA?
S. aureus (or Staph) including MRSA can be spread among people having close contact with an infected person. MRSA is almost always spread by direct physical contact and not through the air. However, spread may also occur through indirect contact by touching objects (e.g., towels, sheets, wound dressings, clothes, workout areas, or sports equipment) contaminated with Staph bacteria or MRSA.
Staph bacteria can live on the skin or in the nose of healthy individuals without causing any symptoms of disease. This is known as colonization and MRSA can also be carried in this way. However, injury to the skin (e.g. scrape or cut) can allow an opportunity for bacteria to enter the skin and cause an infection.
Infections caused by Staph or MRSA are usually mild, limited to the surface of the skin, and can be treated successfully with proper hygiene and antibiotics. In rare cases, if left untreated or not recognized early, MRSA infections can be difficult to treat and can progress to life-threatening blood or bone infections because there are fewer effective antibiotics available for treatment.
MRSA infections occur most commonly among persons in hospitals and healthcare facilities. However, MRSA can cause illness in persons outside of hospitals and healthcare facilities as well. Cases of MRSA infection in the community setting (e.g. day care centers, schools, prisons) are called Community-Associated Methicillin Resistant Staphylococcus aureus (or CA-MRSA ) and have been associated with recent antibiotic use, sharing contaminated personal items, reoccurring skin infections, and living in crowded settings.
How do I know if I am at risk of getting a Staph or MRSA in the community setting?
Persons with MRSA infections that meet all or some of the following criteria listed below may have a Community-Associated MRSA (CA-MRSA) infection, but should seek additional information from a healthcare provider to confirm a suspected MRSA infection:
- Diagnosis of MRSA was made in the outpatient setting (e.g. primary care clinic) or by a positive culture for MRSA within 48 hours after admission to a hospital.
- The patient has no medical history of MRSA infection or colonization
- The patient has no medical history in the past year of:
- Admission to a nursing home, skilled nursing facility, or hospice
- Surgery (including minor procedures)
- Recent or Frequent antibiotic use (within 6 months)
- Direct contact with an infected person
- The patient has no permanent indwelling catheters or medical devices (e.g. IV) that pass through the skin into the body.
- Use of sports facilities or work out areas in a community setting (e.g. school) where CA-MRSA or MRSA cases have been identified.
- Sharing of personal items (e.g. uniforms, razors, and washcloths) that have been used by a person infected with MRSA or a person with a history of MRSA infection.
If my doctor or healthcare provider has told me that I have a Staph or MRSA skin infection, what can I do to prevent others from getting infected?
You can prevent the spread of MRSA or Staph to those you live with or others around you by following these steps:
Keep infections, particularly those that continue to produce pus or to drain material, covered with clean, dry bandages. Keep the infected area clean by washing with soap and water and then covered with a dry bandage. Talk to your health care provider about proper wound care for skin infections. Pus from infected wounds can contain MRSA and spread the bacteria to other parts of the body and to other people.
Advise your family and other close contacts to wash their hands frequently with soap and warm water, especially if they change your bandages or touch the infected wound or ANY potentially infectious materials.
Avoid sharing personal items (e.g., towels, washcloths, razors, clothing, or uniforms) that may have had contact with the infected wound and potentially infectious material. Wash bed linens and clothes that come into contact with the infected wound with hot water and laundry detergent until the infection has cleared. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
Tell any available healthcare providers (e.g. primary care doctor or school nurse) if you suspect you may have Staph skin infection.
If my child uses athletic facilities (e.g. weight room) or is involved in athletics, what additional measures can be taken prevent and control MRSA infections within the athletic setting?
Athletes, athletic personnel, and parents can help prevent and control MRSA infections within the athletic setting by following these simple health and hygiene practices.
In addition, athletes who participate in sports involving direct physical contact (e.g. wrestling and football) and athletes participating in sports that do not involve direct physical contact, but who share workout areas should follow these health and hygiene practices listed below to help prevent and control MRSA within the athletic setting:
Wash hands frequently with soap and water, especially after using any sports facilities.
Avoid sharing personal items (e.g., towels, washcloths, razors, clothing, or uniforms) that may have had contact with and infected individual or potentially infectious material.
Report any suspicious skin sore or boil to your healthcare provider and school nurse immediately.
If you participate in sports involving close personal contact (e.g. wrestling and football) shower with soap immediately after each practice, game, or match.
Non-washable gear (e.g. head protectors), should be wiped down with alcohol after each use.
Athletic equipment such as wrestling or gymnastics mats should be wiped down regularly with an antibacterial solution (e.g. Hibiclens).
Athletes involved in close contact sports should receive a total body check by the appropriate athletic personnel prior to any game, match or tournament.
Individuals with an infection involving drainage (e.g. pus drainage), who are involved in close contact sports, should be excluded from participation in sporting events and practices until no pus drainage is present and the infected site can be adequately covered with a bandage and clothing.
Any cut or break in the skin should be washed with soap and water and a clean, dry dressing applied on a daily basis, before and after participation in close contact sports, and after using any sports facilities.
Tell your healthcare provider (e.g. primary care doctor or school nurse) and the appropriate athletic personnel if you currently have or have had a history of an antibiotic-resistant Staph skin infection(s).
How is an MRSA Infection Diagnosed?
A sample from the infected wound (either a small biopsy of skin or pus taken with a swab) must be obtained to grow the bacteria in the microbiology laboratory. Once the S taph is growing, the organism is tested to determine which antibiotics will be effective for treating the infection. A culture from a known or suspected skin infection is especially useful in recurrent or persistent cases of skin infection, in cases of antibiotic failure, and in cases that present with advanced or aggressive infections (e.g. bloodstream infections).
Do people die from CA-MRSA infections?
CA-MRSA infections are typically limited to the skin and do not usually result in severe disease (such as infection of the bloodstream). However, on rare occasions, CA-MRSA can cause life-threatening illness and death even when treated quickly.
I have heard this bacterium is attacking healthy people and healthy skin. Is this what the Centers for Disease Control and Prevention (CDC) are seeing?
Yes, S taph infections commonly affect healthy people and healthy skin. Usually, these infections are easily treated. Any activity that promotes a breakdown in the skin (e.g., chronic skin infections, physical trauma, and poor health) can promote S taph infections including those caused by MRSA.
Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
People with increased exposure to antibiotics and the healthcare setting may be at increased risk for antibiotic-resistant infections of various kinds, including MRSA. People with compromised immune systems, which include some patients with HIV, diabetes, or on chemotherapy, may be at risk for more severe illness if they get infected with Staph or MRSA.
Why does the CDC think so many cases of MRSA are being recognized across the country?
MRSA has been recognized as a problem in the healthcare setting for over 20 years. The CDC believes that MRSA has been emerging in the community over the last several years for reasons that are unknown. It is difficult to determine whether there is an increase in MRSA disease in the community or an increased awareness and recognition of MRSA disease. However, it is clear that some of the recently recognized outbreaks of CA-MRSA are associated with strains that have some unique properties compared to the traditional hospital-based MRSA strains. However, further testing and confirmation of CA-MRSA are needed.
Are all the cases of CA-MRSA in the U.S. caused by the same strain of Staph? Are these cases all related?
No. At present, there appears to be at least three different known strains of staphylococci that can cause CA-MRSA infections in the U.S. The unique properties associated with cases of CA-MRSA thus far have varied greatly across various geographic regions where outbreaks have occurred and appear unrelated. The CDC continues to work with state and local health departments to gather epidemiologic data from all the cases that have been identified to determine why certain groups of people get infections with these organisms in the community. Efforts to evaluate Staphylococci infection in the community setting from around the U.S. are ongoing.
What is CDC doing about CA-MRSA?
Public Health Response
- CDC is providing technical assistance to various professional organizations and state and local health departments to develop guidance for prevention and control of MRSA and CA-MRSA.
- CDC is beginning a national program of surveillance for serious infections with MRSA.
This information is being provided by the Mecklenburg County Health Department and has been adapted from the Centers for Disease Control and Prevention a division of the Department of Health and Human Services. Further details about MRSA and CA-MRSA are available at http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html.
For more information, please contact:
Sara Zimmerman, MPH
Mecklenburg County Health Department