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Table of Contents
COMMENTARY
Year : 2022  |  Volume : 1  |  Issue : 4  |  Page : 199-201

MRSA infection prevention and control – Where do we stand?


1 Department of Pathology and Laboratory Medicine, National Institute of Cardiovascular Diseases, Karachi, Pakistan
2 Department of Forensic Medicine, Dow University of Health Sciences, Karachi, Pakistan
3 Department of Medicine, Hamdard College of Medicine and Dentistry, Karachi, Pakistan

Date of Submission29-Jul-2022
Date of Decision31-Aug-2022
Date of Acceptance01-Sep-2022
Date of Web Publication5-Dec-2022

Correspondence Address:
Tazeen Fatima
Department of Pathology and Laboratory Medicine, National Institute of Cardiovascular Diseases, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpdtsm.jpdtsm_72_22

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How to cite this article:
Fatima T, Fatima M, Fatima T. MRSA infection prevention and control – Where do we stand?. J Prev Diagn Treat Strategies Med 2022;1:199-201

How to cite this URL:
Fatima T, Fatima M, Fatima T. MRSA infection prevention and control – Where do we stand?. J Prev Diagn Treat Strategies Med [serial online] 2022 [cited 2023 Jan 29];1:199-201. Available from: http://www.jpdtsm.com/text.asp?2022/1/4/199/362824



Staphylococcus aureus is by far the most common and important human pathogen among the genus staphylococci. These Gram-positive cocci are not only found in an external environment but also commonly found as colonizers on human skin folds, anterior nares, perineum, axilla, and vagina. It is known to cause a wide spectrum of infections ranging from benign folliculitis, cellulitis, furuncles, carbuncles, impetigo, mastitis, surgical wound infections, and food poisoning to more invasive skin and soft-tissue infections and systemic illnesses such as osteomyelitis, endocarditis, bronchopneumonia, meningitis, pericarditis, pyomyositis, bloodstream infections, scalded skin syndrome, and toxic shock syndrome. S. aureus is one of the most common causes of nosocomial and health care-associated infections. In 1960s, infection was generally associated with health-care contact as the first clinical isolates of methicillin-resistant S. aureus (MRSA) were isolated from hospitalized patients, but since the 1990s cases of MRSA infection developed in individuals who had no previous hospitalization, leading to distinct classifications for health care-associated MRSA (HA-MRSA) and community-acquired MRSA (CA-MRSA).[1],[2] Since then, it has spread rapidly in the community and the highest risk of CA-MRSA acquisition is usually found in children, the elderly population, intravenous drugs users, athletes, military personnel, individuals with HIV, diabetes or cystic fibrosis, dialysis-dependent individuals, and residents of long-term care facilities including prisoners. The risk of HA-MRSA infections is usually seen in health-care workers (HCWs), those with frequent health-care contact, and a history of previous hospitalization, surgery, and antibiotic use.[3],[4],[5],[6]

Increasing the incidence of MRSA infections in the past few decades has become a pronounced challenge to treat complicated infections due to the availability of limited and expensive therapeutic drugs and that too with gradual accumulation of resistance to available antibiotics. The frequency of MRSA infections has increased from 35% to around 51% in the past decade only.[7] Currently, a prevalence of >60% is reported from different hospitals across Pakistan and the incidence is increasing every year.[8] It can be said that even these high numbers may be a downplay of factual numbers and the infection rate maybe even higher then reported. There are a lot of reasons for this underreporting as there are a lot of gaps in patients' management pathways. These include unawareness in the community and public health sector regarding the importance of diagnostic stewardship, inaccessibility to health services, unavailability of quality controlled microbiological testing facilities and standardized methodology and nonexistence of framework in many hospitals and laboratory setups for reporting of rates of multidrug resistant infections to national surveillance authorities and no model for local antibiogram formation. Only available data is from local antibiograms or studies from a single center with limited sample sizes so cannot be generalized.

The tendency of MRSA to become human commensal and skin colonizer, and rapid dissemination from direct or indirect contact is one of its most significant and key virulence factors. The risk of subsequent infections is believed to increase by 23%–30% after colonization occurs, and therefore, colonization is thought to be critical for both hospitalized and outpatient populations.[9],[10],[11],[12],[13]

Contact precautions consist of isolation of patients through placing infected/colonized patients in a single room or cohorting them together, use of personal protective equipment such as gown and gloves for all contact with the patient, patient surrounding, or their environment, and use of dedicated patient-care equipment are the primary infection control procedure for restricting the nosocomial spread of MRSA, as recommended by the Center for Disease Control and Prevention.[14] Another strategy employed by some health-care institutes is performing admission screening cultures for MRSA by obtaining nasal, axillary, groin, oropharyngeal, forehead, perineal, rectal, perirectal, and even intestinal samples swabs.[15],[16],[17],[18] Screening of 2–3 site body sites can increase the yield of bacteria and therefore improve detection.[19],[20],[21],[22] Patients who tested positive for MRSA are isolated using isolation precautions and are treated concomitantly by different regimens for MRSA decolonization. There are a number of different combinations of protocols used for decolonization including chlorhexidine baths, 2% intranasal mupirocin application, washing with povidone-iodine soap, and systemic antibiotics such as oral regimens of rifampicin and clindamycin.[23] Screening and decolonization of HCWs are an additional tactic to approach this problem as the colonization of HCWs is a common cause of the nosocomial spread of MRSA. Unknown colonization status of HCWs may lead to a state of unawareness where they are not careful and conscious to follow contact precautions while interacting with the patients. However, the effectiveness of MRSA screening in HCWs is still a debatable topic and there is uncertainty regarding its efficacy as there are no established protocols for its usage. Although several studies have attempted to describe the best methods for screening and decolonization and a number of prospective trials reported a success rate ranging from 25% to 95%,[10] there still are no standardized guidelines. Screening, contact isolation precautions, and hand hygiene practices when combined, have shown promising results to reduce infection rates by as much as 40%–60%.[24],[25],[26] Nonetheless, should it be used as a rational infection control strategy considering the costs and resources required, remains a question. More research is required to define the best algorithms for screening and efficacy of different decolonization strategies and protocols in resource-limited settings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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