Methicillin -resistant [1] Staphylococcus aureus ( English Methicillin-resistant Staphylococcus aureus ) - Staphylococcus aureus , which causes difficult diseases in humans, such as sepsis , pneumonia . It is also called: Staphylococcus aureus with multidrug resistance, or Oxacillin-resistant Staphylococcus aureus. Methicillin-resistant staphylococcus is any strain of Staphylococcus aureus bacteria that is resistant to a large group of antibiotics - beta-lactams (include penicillins and cephalosporins ).
| Bacteria group | |
|---|---|
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| Title | |
| Methicillin-resistant Staphylococcus aureus | |
| Title Status | |
| not determined | |
| Parent taxon | |
| Species Staphylococcus aureus ( Staphylococcus aureus ) | |
| Representatives | |
| Infection of the population of Europe in 2008 | |
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Methicillin-resistant staphylococcus adapted to survival in the presence of methicillin , dicloxacillin and oxacillin . Most often, nosocomial infections are associated with it. In hospitals, patients with open wounds and a weakened immune system are at greater risk of infection than other patients. Hospital staff who do not follow proper sanitary rules can transfer bacteria from patient to patient. Visitors with methicillin-resistant staphylococcus infection are advised to follow the protocol of the infectious diseases hospital: use gloves, gowns and masks if indicated. Visitors, including medical personnel who do not follow such protocols, contribute to the spread of bacteria in dining rooms, bathrooms, elevators and various other rooms.
In addition to nosocomial, since the 1990s, household methicillin-resistant staphylococcus, which is not associated with traditional risk factors, has been isolated. Domestic (CA-MRSA - community-acquired methicillin-resistant Staphylococcus aureus) methicillin-resistant staphylococcus has a mecA-resistant gene of types 4 and 5 in the chromosome, in contrast to nosocomical methicillin-resistant staphylococcus in which this gene is 1-3 types. It is also likely that household methicillin-resistant staphylococcus contains Panton Valentine leukocidin genes that cause increased virulence . The control of household methicillin-resistant staphylococcus is identical to the control of the nosocomial variety, however there is a greater selection of antibiotics. For example, percutaneous drainage is sufficient for the treatment of uncomplicated skin abscess. For deeper and more serious lesions, co-trimoxazole , clindamycin , tetracycline ( doxycycline , minocycline ), linezolid are used until susceptibility to antibiotics is established. Tetracycline cannot be used in the treatment of children under 8 years of age. When impetigo is used locally, mupirocin [2]
Methicillin-resistant staphylococcus is often referred to as the causative agent of community-acquired methicillin-resistant staphylococcal infections or health-related methicillin-resistant staphylococcal infections, although this difference is complex. The first cases of community-acquired methicillin-resistant staphylococcal infections were described in the mid-1990s in Australia, New Zealand, the United States, the United Kingdom, France, Finland, Canada, and the peculiarity was that people who did not stay in medical institutions fell ill. Community-acquired new strains of methicillin-resistant staphylococcus have quickly become the most common cause of skin infection among people seeking medical care in urban areas of the United States. These strains also often cause skin infections in athletes, prisoners and soldiers. However, in many cases, children who needed hospitalization also became ill. About 18,000 Americans die every year from methicillin-resistant staphylococcal infections.
History
Methicillin-resistant staphylococcus aureus was first recorded in the UK in 1961 . In the United States, this pathogen was first noted in 1981 among drug addicts who injected drugs. Later, in 1997, four childhood deaths due to methicillin-resistant staphylococcus infections were reported in Minnesota and North Dakota. Available statistics indicate that the staphylococcal epidemic is getting out of hand. The incidence and mortality rate of this disease is difficult to determine. According to population-based morbidity studies conducted in San Francisco in 2004-2005, the number of infections per year was about 1300 cases. The study showed that patients infected with Staphylococcus aureus are forced to spend on average three times as much in the hospital (14.3 days versus 4.5 days), and the risk of death in this case is five times higher (11.2% versus 2.3% ) than in patients without this infection.
A 2009 scientific article discusses the relationship between the increase in staphylococcus resistance in the United States and the increase in the number of lawyers involved in medical litigation [3] .
Clinical manifestations
Staphylococcus aureus most often persists in the upper parts of the nasal passages and respiratory tract , in open wounds and urinary tract . In healthy people, the disease can be asymptomatic for a period of several weeks to many years. Patients with impaired immune systems have a significantly higher risk of symptomatic infection.
Additional sanitary measures were taken for those who are in contact with infected people: relatives, medical personnel. They are recognized as effective in minimizing the spread of infection in hospitals in the United States, Denmark, Finland and the Netherlands.
Significant progression of the infection process is observed within 24-48 hours after the initial topical symptoms . After 72 hours, bacteria can penetrate human tissues and become resistant to the action of drugs. Initially, small red bumps appear that resemble acne, spider bites, which can be accompanied by fever , sometimes a rash . After a few days, the bumps become larger, more painful, and can be filled with pus . About 75% of methicillin-resistant staphylococci are localized on the skin, soft tissues and can undergo effective treatment. However, the strains have increased virulence and cause diseases more serious than traditional staphylococcal infections. They can affect vital organs and lead to widespread infections ( sepsis ), toxic shock syndrome, and necrotic pneumonia . It is believed that this is due to toxin strains . It is not known why some healthy people develop skin infections that are treatable, while others who are infected with the same strain develop a severe infection that can be fatal.
The most common manifestations are skin infections , necrotic fasciitis, pyomyositis, necrotic pneumonia, infectious endocarditis (which affects the heart valves ). Often the infection leads to the formation of abscesses , which requires surgical intervention.
Risk Groups
The high-risk group includes:
- People with a weakened immune system (people with HIV / AIDS , cancer, patients after organ transplants, severe asthmatics, etc.);
- Patients with diabetes ;
- People who inject drugs;
- Patients taking quinolone antibiotics ;
- Children;
- Elderly people;
- Students living in dormitories;
- Persons staying or working in medical facilities for a long period of time;
- People who spend time in coastal waters, on beaches;
- People who spend time in a confined space with other people, including prisoners, soldiers, athletes.
Staph infections are observed mainly in hospitals and medical facilities, in nursing homes. However, it should be noted that the infection can also occur outside hospitals - in closed systems, such as prisons, with the constant admission of new prisoners, as a rule, with poor health and not observing personal hygiene. Cases of infection have increased in livestock production - mainly pigs, as well as cattle and poultry, from which the pathogen can be transmitted to humans, become ill. In the US, there has been an increase in reports of outbreaks of skin transmitted infections in locker rooms and gyms, even among healthy populations. Also, methicillin-resistant staphylococcal infection becomes a problem in pediatrics.
Infection Prevention and Control
- Screening system
- Surface disinfection - Ethyl alcohol has proven to be an effective disinfectant. To prolong the disinfection effect in combination with ethyl alcohol, quaternary ammonium can be used. In medical facilities, methicillin-resistant staphylococcus can survive on the surfaces, on the clothing of medical workers. Full surface sanitation is required in treatment rooms.
- Personal hygiene
- Isolation of patients with suspected (or confirmed) infection with Staphylococcus aureus
- Limited and rational use of antibiotics
Laboratory Diagnostics
Outbreaks of methicillin-resistant staphylococcal infection are detected by diagnostic microbiological and reference laboratories. There are express methods to determine the type and characterize the pathogen strain. Methods such as real-time PCR or quantitative PCR are increasingly used in clinical laboratories to quickly detect and identify strains of methicillin-resistant staphylococcus.
Another commonly used laboratory test is the latex agglutination test, which allows you to determine the Ξ²-lactam- resistant penicillin-binding protein PBP2a, which gives Staphylococcus aureus resistance to methicillin and oxacillin.
See also
- Vancomycin-resistant Staphylococcus aureus
- SQ109
Notes
- β Digital library of the Far Eastern State Medical University :: METICILLIN-RESISTANT GOLDEN STAFILOCOCCES: THE PROBLEM OF DISTRIBUTION IN THE WORLD AND RUSSIA . www.fesmu.ru. Date of treatment October 3, 2016.
- β Berkowitz's Pediatrics: A Primary Care Approach, 5th Edition Copyright Β© 2014 American Academy of Pediatrics p.346
- β Sakoulas G. , Wormser GP , Visintainer P. , Aronow WS , Nadelman RB Relationship between population density of attorneys and prevalence of methicillin-resistant Staphylococcus aureus: is medical-legal pressure on physicians a driving force behind the development of antibiotic resistance? (Eng.) // American journal of therapeutics. - 2009. - Vol. 16, no. 5 . - P. e1β6. - DOI : 10.1097 / MJT.0b013e3181727946 . - PMID 19955854 .