Methicillin resistant staphylococcus aureus risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk Factors

MRSA occurs most frequently among

• Patients who undergo invasive medical procedures such as:
  • Nasogastric tube
  • Gastrostomy tube
  • Foley catheter
  • Total parenteral nutrition or enteral feeding
  • Mechanical ventilation with endotracheal tube or tracheostomy tube
  • Invasive indwelling devices
  • Hemodialysis or peritoneal dialysis
• Patients who are being treated in hospitals and healthcare facilities such as nursing homes and dialysis centers.
• People with weak immune systems - immunosuppression (people living with HIV/AIDS, people living with lupus, cancer patients, transplant recipients, severe asthmatics, etc.)
• Diabetics
• Chronic illness
• Intravenous drug users
• Users of quinolone antibiotics
• Young children, especially those in day care centers
• The elderly
• College students living in dormitories
• People staying or working in a health care facility for an extended period of time
• People who spend time in coastal waters where MRSA is present, such as some beaches in Florida and the west coast of the United States
• People who spend time in confined spaces with other people, including occupants of homeless shelters and warming centers, prison inmates, military recruits in basic training, and individuals who spend considerable time in changerooms or gyms.
• Men who have sex with men
• Urban under-served
• Indigenous populations, including Native Americans, Native Alaskans, and Australian Aboriginals
• Veterinarians, Livestock handlers, and Pet owners

Hospital patients

Many MRSA infections occur in hospitals and healthcare facilities, with a higher incidence rate in nursing homes or long-term care facilities. When infections occur in this manner it is known as healthcare acquired MRSA or HA-MRSA. These rates of MRSA infection are also increased in hospitalized patients who are treated with quinolones. Healthcare provider-to-patient transfer is common, especially when healthcare providers move from patient to patient without performing necessary hand-washing techniques between patients.

Prison inmates, Military recruits, and the Homeless

Prisons, military barracks, and homeless shelters can be crowded and confined, and poor hygiene practices may proliferate, thus putting inhabitants at increased risk of contracting MRSA. Cases of MRSA in such populations were first reported in the United States, and then in Canada. The earliest reports were made by the CDC in state prisons. Subsequently, reports of a massive rise in skin and soft tissue infections were reported by the CDC in the Los Angeles County Jail system in 2001, and this has continued. Pan et al. reported on the changing epidemiology of MRSA skin infection in the San Francisco County Jail, noting the MRSA accounted for more than 70% of S. aureus infection in the jail by 2002. Lowy and colleagues reported on frequent MRSA skin infections in New York State Prisons. Two reports on inmates in Maryland have demonstrated frequent colonization with MRSA.

In the news media, hundreds of reports of MRSA outbreaks in prisons appeared between 2000 and 2008. For example, in February 2008, The Tulsa County Jail in the U.S. State of Oklahoma started treating an average of twelve Staphylococcus cases per month. A report on skin and soft tissue infections in the Cook County Jail in Chicago in 2004–05 demonstrated that MRSA was the most common cause of these infections among cultured lesions. Furthermore, few risk factors were more strongly associated with MRSA infections than infections caused by methicillin-susceptible S. aureus. In response to these and many other reports on MRSA infections among incarcerated and recently incarcerated persons, the Federal Bureau of Prisons has released guidelines for the management and control of the infections, although few studies provide an evidence base for these guidelines.

People in contact with live food-producing animals

Cases of MRSA have increased in livestock animals. CC398 is a new clone of MRSA that has emerged in animals and is found in intensively reared production animals (primarily pigs, but also cattle and poultry), where it can be transmitted to humans. Though dangerous to humans, CC398 is often asymptomatic in food-producing animals.

A 2011 study reported 47% of the meat and poultry sold in surveyed U.S. grocery stores was contaminated with S. aureus and, of those, 52%—or 24.4% of the total—were resistant to at least three classes of antibiotics. "Now we need to determine what this means in terms of risk to the consumer," said Dr. Keim, a co-author of the paper. Some samples of commercially sold meat products in Japan were also found to harbor MRSA strains.

Athletes

In the United States, there have been increasing numbers of reports of outbreaks of MRSA colonization and infection through skin contact in locker rooms and gyms, even among healthy populations. A study published in the New England Journal of Medicine linked MRSA to the abrasions caused by artificial turf. Three studies by the Texas State Department of Health found that the infection rate among football players was 16 times the national average. In October 2006, a high school football player was temporarily paralyzed from MRSA-infected turf burns. His infection returned in January 2007 and required three surgeries to remove infected tissue, as well as three weeks of hospital stay.

Children

MRSA is also becoming a problem in pediatric settings, including hospital nurseries.