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            Methicillin Resistant Staphylococcus Aureus (MRSA) screening is prescribed for many strains of Staphylococcus Aureus bacteria that are resistant to most antibiotics for instance; methicillin is normally prescribed for treating skin infections. Staphylococcus Aureus is a bacterium that lives inside the nose and on the skin surface. It is usually harmless hence majority of people carrying this bacteria are absolutely not aware of having it. However, they have proven to be virulent in some cases, producing toxins thus causing an invasive-infection. MRSA causes infections in both the old and the young and even previously healthy persons without apparent risk-factors. The bacteria are spread by MRSA infected or colonized persons through close-contact as well as through contaminated objects like shared towels or razors. It appeared first in early 1960s and outbreaks in confined populations such as nursing homes, hospitals and prisons have been of concern for decades. According to Moreno (1303-12), MRSA screenings are tests that solely detect the presence of MRSA and not any other pathogens. It is mainly used to determine remains of these resistant-bacteria at the site of a wound after MRSA infection has been treated or to identify MRSA presence in a person who has been colonized.

How MRSA Screening is done

Culture is the most widely used test in identification of MRSA colonization. It confirms whether resistant bacteria is present and allows it to be categorized further except that cultures take some time, about 1-2 days. A nasal-swab is obtained from the nostrils of a person who has the symptoms. This is done by rotating a swab inside each nostril to collect nasal swab. Culturing entails putting the specimen onto a nutrient medium that is special, incubated and later MRSA colonies growth characteristics are examined. Swabs of skin lesion or wound-infection site are occasionally collected from an individual treated previously for MRSA infection and cultured in a similar manner.

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Why Some Hospitals Routinely Carry Out Active MRSA Screening

More and more hospitals are incorporating decolonization and nasal screening programs for patients with high surgical site infections (SSI’s) risk into their pre-surgical testing routine protocol. Some hospitals have established measures to control MRSA from spreading   by screening carriers (patients standing high risk of being colonized with MRSA bacteria) or all hospital new admissions. Screening of MRSA infections would lower additional hospitalizations, revision surgeries, reduce recurrent infection incidences and intravenous antibiotic usage. In MRSA endemic environment, targeted or universal screening of ICU patients is a vital pillar in MRSA-control program to detect colonization together with decolonizing carriers with high infection risk either to others or self in a hospital.

Expert group recommended that patients be screened before admission if they would be admitted or on admission to identify any risk through clinical-risk-assessment approach. Patients of high risks would have their swabs tested further in the laboratory. Patient in ICU, cardiothoracic, renal, vascular and orthopaedics would be tested routinely using swabbing to reduce MRSA transmission among patients. This is due to the fact that the cost of taking care of MRSA patient is very high hence calls for interventions that would lower its spread such as screening ICU patients before admission. Furthermore, many ICU patients have catheter or intravenous drip which can create an injury through which the resistant bacteria can get nto the body. Besides, patients are close to one another in some hospitals hence increases rate of MRSA infection among patients. What is more, many opportunities are offered to S. Aureus bacteria to come across a variety of antibiotics and develop resistance to those antibiotics through survival and genetic change in many hospitals. Under conservative assumptions, MRSA screening of intensive care unit patients is cost neutral if it can hinder or lower rate of transmission and infection in a hospital. According to Gaynes and Horan (452-5), hospitals contain people having weak immune systems due to either illness or surgery like heart surgery, and could easily be infected with resistant bacteria and develop other serious problems and unwanted symptoms.

Why Some Hospitals do not carry out Active MRSA Screening

            Some Hospitals in U.S. do not carry out Active MRSA Screening is simply because in all circumstances, screening procedures carry a significant cost burden to patients yet others cannot meet such costs. In addition, in other hospitals each patient stay in his own room thus reducing this risk. Besides, it may be useful to carry out staff screening but it becomes a problem in distinguishing between long term colonization and transient carriage. Moreover, identifying staff who are MRSA-positive may have consequences such as low staff moral and inability to retain staff in such hospitals.

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When Active MRSA Screening is ordered

 MRSA screening-test can be done when a hospital, doctor, researcher or community-health department would like to evaluate MRSA colonization potential in a person, his family members or certain community members to determine MRSA infection source. Specific people who have close physical-contact like residents of a nursing home, health care workers, a soccer team can be tested to find out their MRSA carrier status when there are increased incidences of the bacteria within groups that they are close. An individual earlier treated for MRSA colonization or MRSA infection might be screened to determine presence of MRSA.

Treatment of MRSA infection in Patients

                               It is difficult to treat MRSA since it is resistant to several different antibiotics compared to non-resistant bacteria. However, most MRSA strains can be treated using vancomycin, mupirocin and teicoplanin. A patient having MRSA can apply antimicrobial ointment to the nostrils to decolonize the resistant bacteria. By eradicating nasal colonization, a patient can be prevented from spreading the bacteria to others or infecting his own skin after cardiac surgery.  Before surgery, povidone-iodine or mupirocin ointment can be applied to nostrils as they are effective in decolonizing Staphylococcus Aureus that is short term. Antibiotics can clear infections in people who have weakened immune-systems.
                               For individuals having weakened immune-systems and are infected with resistant bacteria can be best treated using vancomycin or teicoplanin antibiotics. Vancomycin or teicoplanin are administered as injections or through intravenous-drip therefore, only given in hospital. Healthy persons having MRSA are treated with  mupirocin cream and is applied on  areas of the body that haave been affected, aimed at  reducing chances of resistant  bacteria getting into the body via  an open-wound or other persons  catching it.

Is Vancomycin the Gold-Standard Treatment?

Vancomycin is a glycopeptide antibiotic. It has been in use for over 60 years in MRSA treatment. It acts by blocking synthesis of the cell wall. It is extremely rare for Staphylococcus  Aureus to be resistant tovancomycinis in the medical world. For that reason, it has been widely used in treating infections particularly strains resistant to drug that belong to methicillin group. However, issue of vancomycin effectiveness in treating certain MRSA infections has been raised in recent literature. Numerous articles have described vancomycin mono therapy limitations in treating MRSA-pulmonary infections. Reports show that vancomycin mono therapy has failed to treat 40 percent lower respiratory tract infections caused by MRSA due to its poor penetration into tissues of the lung (Hus 569-70).  However, there is evidence in other reports  indicated that the drug’s ineffectiveness was as a result of poor drug preparations from the initial stages as it had some impunities.

All drugs have side effects but majority of them have minor or no side effects resulting from drug usage. No common adverse effects have been reported by patients on vancomycin. However, bloody stools, fever, chest pain, sore throat, severe diarrhea,  chills, decrease in urine amount or urination frequency as well as severe allergic reactions (itching, swelling of the face and tongue, difficulty in breathing) have been reported by some patients.

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Teicoplanin is a glycopeptide antibiotic. It inhibits synthesis of peptidoglycan thereby inhibiting susceptible microbes’ cell wall synthesis. It does so by binding to amino-acids found inside the cell wall thus addition other more peptidoglycan units are prevented. However, coagulase negative Staphylococci are more sensitive to vancomycin than to teicoplanin. Symptomatic side effects resulting from use of teicoplanin include dizziness, fever headache, tinnitus, rashes, hearing loss, rigors, angioedema and reaction at injection site (Hiramatsu 135-6). The severe adverse side effects resulting from the use of Teicoplanin include Ototoxicity, Bronchospasm, Renal failure and Eosinophilia, which may further result into complications.

Mupirocin

Mupirocin is a topical antibiotic. It is applied topically on the skin for impetigo (a bacterial disease affecting the skin brought about by Staphylococcus Aureus) treatment. It can also be applied in the nose by some healthcare center workers and by patients to get rid of MRSA inside the nose. Mupirocin blocks isoleucyl- tRNA synthetase enzyme activity inside the bacteria that is necessary for protein production by the bacteria. Hence bacteria die due to inability to produce proteins. Probability of MRSA bacteria becoming resistant to mupirocin antibiotic is zero due to its unique action mechanism regardless of MRSA exposure to different antibiotics. According to Murray (710-21), burning, pain, itching, and erythema are some of the side effects that have been reported to accompany the use mupirocin.

Conclusion

            Methicillin Resistant Staphylococcus Aureus (MRSA) screening is vital in very hospital not only for ICU patients but all other patients on admission if our hospitals have to effectively control the infection and spread of Staphylococcus Aureus bacteria among people.

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