![Cont…
19. Duckworth G. Controlling methicillin-resistant Staphylococcus aureus. BMJ 2003;327: 1177–8[PMC free
article] [PubMed]
20. Voss A. Preventing the spread of MRSA. BMJ 2004;329: 521. [PMC free article] [PubMed]
21. Thompson DS. Methicillin-resistant Staphylococcus aureus in a general intensive care unit. J R Soc Med2004;97:
521–6 [PMC free article] [PubMed]
22. Rolinson GL, Stevens S, Batchelor FR, Cameron Wood J, Chain EB. Bacteriological studies on a new
penicillin. Lancet 1960;ii: 564–9 [PubMed]
23. Elek SD, Fleming PC. A new technique for the control of hospital cross infection. Lancet 1960;ii: 569–
72[PubMed]
24. Jevons MP. ‘Celbenin-resistant’ staphylococci. BMJ 1961;i: 124–5
25. Cox RA, Conquest C, Mallaghan C, Marples RR. A major outbreak of methicillin-resistant staphylococci caused by
a new phage type (EMRSA-16). J Hosp Infect 1995;29: 87–106 [PubMed]
26. Farrington M, Redpath C, Trundle C, Coomber S, Brown NM. Winning the battle, but losing the war: methicillin-
resistant Staphylococcus aureus (MRSA) at a teaching hospital. Q J Med 1998;91: 539–48[PubMed]
27. British Society for Antimicrobial Chemotherapy, Hospital Infection Society, Infection Control Nurses Association.
Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. J Hosp
Infect 1998;39: 253–90 [PubMed]
28. Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ETM. The Second National Prevalence Survey of
Infection in Hospitals—overview of the results. J Hosp Infect 1996;32: 175–90 [PubMed]
29. Barrett SP, Mummery RV, Chattopadhyay. Trying to control MRSA causes more problems than it solves. J Hosp
Infect 1998;39: 85–93 [PubMed]
30. Farrington M, Redpath C, Trundle C, Brown NM. Controlling MRSA. J Hosp Infect 1999;40: 251–4[PubMed]
•](https://image.slidesharecdn.com/presentation1-150131122641-conversion-gate01/85/MRSA-44-320.jpg)
![Cont…
31. Cooper BS, Stone SP, Kibbler CC, et al. Isolation measures in the hospital management of methicillin-
resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004;329: 533–9[PMC free
article] [PubMed]
32. Wertheim HFK, Vos MC, Boelens HAM, et al. Low prevalence of methicillin-resistant Staphylococcus
aureus (MRSA) at hospital admission in the Netherlands: the value of the search and destroy and restrictive
antibiotic use. J Hosp Infect 2004;56: 321–5 [PubMed]
33. Marshall C, Wolfe R, Kossman T, Wesselingh S, Harrington G, Spelman D. Risk factors for acquisition of
methicillin-resistant Staphylococcus aureus by trauma patients in the intensive care unit. J Hosp Infect2004;57:
245–52 [PubMed]
34. Silvestri L, van Saene HKF, Milanese M, et al. Prevention of MRSA pneumonia by oral vancomycin
decontamination: a randomised trial. Eur Respir J 2004;23: 921–6 [PubMed]
35. de la Cal MA, Cerda E, van Saene HKF, et al. Effectiveness and safety of enteral vancomycin to control
endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit. J Hosp
Infect 2004;56: 175–83 [PubMed]
36. Van Saene HKF, Weir WI, de la Cal MA, Silvestri L, Petros AJ, Barrett SP. MRSA—time for a more pragmatic
approach. J Hosp Infect 1998;56: 175–83
37. Howe R, Monk A, Wootton M, Wash T, Enright MC. Vancomycin susceptibility within methicillin-
resistant Staphylococcus aureus lineages. Emerg Infect Dis 2004;10: 855–7 [PMC free article] [PubMed]
38. Dryden MS, Dailly S, Crouch M. A randomised, controlled trial of tea tree topical preparations versus a standard
topical regime for the clearance of MRSA colonisation. J Hosp Infect 2004;56: 283–6 [PubMed]
39. Pancheco-Fowler V, Gaonakar T, Wyer PC, Modak K. Antiseptic impregnated endotracheal tubes for the
prevention of bacterial colonisation. J Hosp Infect 2004;57: 170–4 [PubMed]
40. French GL, Otter J, Shannon KP, Adams NMT, Watling D, Parks MJ. Tackling hospital environmental
contamination with methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional
terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect (in press)[PubMed]](https://image.slidesharecdn.com/presentation1-150131122641-conversion-gate01/85/MRSA-45-320.jpg)
MRSA
- 2. Staphylococus aureus Gram Positive Non-motile Spherical Grows in clumps Resembles clumps of grapes Golden color- colonies Some produce hemolysis Some produces coagulase Produce catalase enzymes
- 3. Virulence Determinants of Staphylococcus aureus
- 4. Frequency of Staphylococcus aureus colonization in carriers on various body sites Nose 100% Skin chest 45% Perineum 60%Ankle 10% Axilla 19% Hand 90% Forearm 45% 4
- 5. S. aureus – as pathogen • virulent factors (toxins and enzymes) • Frequent nosocomial- and community-acquired pathogen • Mode of transmission – contact • Clinical manifestations 1/31/2015 5
- 7. Scalded Skin Syndrome: Classic Toxic Shock
- 8. Systemic Menstrual Toxic Shock
- 9. Cont… • The Staphyloccoccus aureus bacterium, commonly known as staph, was discovered in the 1880s - painful skin and soft tissue conditions • Initially cases were treated by draining the abscess or boil
- 10. Cont… • In the 1940s, medical treatment for S. aureus infections became routine as Penicillin was introduced as drug of choice. • Penicillin- bacterial cell wall synthesis- inflow of water- cell burst
- 11. Cont… • But resistance to penicillin in Staph. aureus - due to the presence of penicillinases in them. • Later on due to development of resistance to penicillin
- 12. Cont….. • In 1959 methicillin was introduced for Staph. aureus resistant to penicillinases (Leonard and Markey, 2008) • In recent time resistance leading to use of vancomycin.
- 13. Cont.. • Most strains of MRSA are inhibited by concentrations of vancomycin ranging from 0.5- 2.0 mcg/mL, although strains have been reported with intermediate sensitivity that have been called Glycopeptide intermediate staph aureus or Vancomycin intermediate staph aureus.
- 14. What Is MRSA? • MRSA is the term used for any strain of Staphylococcus aureus that has developed resistance to β- lactam antibiotics, which include the penicillins (methicillins, oxacillin, dicloxacillin etc.) and cephalosporins • MRSA causes a variety of disseminated, lethal infections in humans. • Has the ability to easily transfer resistant genes to other species directly and indirectly
- 15. •Resistance of MRSA to β- lactam antibiotics including penicillinase stable β- lactam is mediated by the mecA gene. •This gene is expressed in bacterial cell wall and encodes for a penicillin binding protein (PBP2a) which has a low affinity for β- lactam antibiotics (Leonard and Markey, 2008). •SCCmec element is a genomic island of unknown origin containing this antibiotic resistant mecA gene (Batabyal et al., 2012). how MRSA is resistant to methicillin?
- 16. How “Tough” is MRSA? • Staphylococci can survive many extreme environmental conditions. • The bacteria can be cultured from dried clinical material after several months, are relatively heat resistant, and can tolerate high salt media. So, “What Do we Do?” • You can not get rid of MRSA; you can only control it.
- 17. How is MRSA spread? 1. Direct contact with infected or colonized host -human-to-human contact 2. Contaminated intermediate surfaces -hand towels -faucets -tub/shower 3. Airborne fluid droplets
- 18. CA-MRSA and HA-MRSA CA-MRSA Unique microbiologic and genetic properties compared with HA-MRSA may allow the community strains to spread more easily or cause more skin disease
- 19. Community-Associated (CA)-MRSA • CA-MRSA has only been known since the 1990s. • CA-MRSA is of great concern to public health professionals because of who it can affect. • CA-MRSA skin infections are known to spread in crowded settings
- 20. Cont… • CA-MRSA is resistant to penicillin and methicillin. • Lead to redness, swelling and pain resembling to spider bite. • Minor skin problems pimples, insect bites, cuts, and scrapes especially in children may lead to MRSA colonization.
- 21. Hospital-acquired MRSA (HA-MRSA) HA-MRSA Healthcare-acquired Methicillin resistant Staph. aureus Many hospitals now seeing CA-MRSA in healthcare associated infections
- 22. Vancomycin resistance……..? • Isolate of S. aureus in 1997 was observed resistant mediated not via acquisition of van A by a strain of methicillin-resistant S. aureus (MRSA) but by an unusually thickened cell wall containing dipeptides capable of binding vancomycin, thereby reducing availability of the drug for intracellular target molecules. • This was the first observation of vancomycin- intermediate S. aureus (VISA).
- 23. Cont…. • The predicted mechanism of van A gene plasmid-mediated transfer from enterococci to S. aureus was later observed for the first time in 2002; this was the first description of vancomycin-resistant S. aureus (VRSA).
- 25. Drugs against MRSA • Daptomycin • Linezolid(belonging to oxazolidiones class)
- 26. Drugs In Development • Oritavancin-Binds to normal cell wall precursors • Tigecyclin-Works on efflux pumps • Dalbavancin- Bacteriacidal
- 27. Who is at risk for MRSA? ANYONE can get MRSA – those most at risk: Spend a lot of time in crowded places such as hospitals, schools or dorms Share sports equipment Share personal hygiene items Play contact sports Overuse or misuse antibiotics
- 28. Can Healthy People Get MRSA? • Yes. MRSA skin infections are showing up more frequently in healthy people, with none of the usual risks factors. • This type of MRSA - called community- associated MRSA (CA MRSA) - has been reported among athletes, prisoners, and military recruits.
- 29. Diagnosis • S. aureus infections in humans are diagnosed by culture and identification of the organism, as in animals. (Staphylococcal food poisoning is diagnosed by examination of the food for the organisms and/or toxins.).
- 30. Cont….. • Methicillin-Resistant Staphylococcus aureus (MRSA) as the causal agent of nosocomial infection demands a quick and trustworthy characterization of isolates
- 31. Phenotypic Methods • Antibiogram typing • Phage typing • Serotyping • Biotyping • Protein electrophoretic typing Whole cell protein typing Immunoblotting Zymotyping
- 32. Genotypic Methods • Plasmid DNA analysis • Chromosomal DNA analysis • Southern blot analysis of RFLP • Ribotyping • Binary typing • Pulsed field gel electrophoresis
- 33. Prevention The best defense against spreading MRSA is to practice good hygiene, as follows: • Keep your hands clean • Use hand sanitizer containing at least 62 percent alcohol. • Keep cuts and scrapes clean and covered with a bandage until healed. • Follow your healthcare provider’s instructions on proper care of the wound. • Bandages or tape can be discarded with regular trash.
- 34. Cont… • Avoid contact with other people’s wounds or bandages. • Avoid sharing personal items, such as towels, washcloths, razors, clothes, or uniforms. • Wash sheets, towels, and clothes that become soiled with water and laundry detergent; use bleach and hot water if possible.
- 35. Cont…. • Drying clothes in a hot dryer, rather than air- drying, also helps kill bacteria in clothes. • Tell any healthcare providers who treat you if you have or had an S. aureus or MRSA skin infection. • If you have a skin infection that requires treatment, ask your healthcare provider if you should be tested for MRSA.
- 36. Cont…. • Many healthcare providers prescribe drugs that are not effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs. • Healthcare providers are fighting back against MRSA infection by tracking bacterial outbreaks and by investing in products
- 37. Vaccination • Development of StaphVAX®, a polysaccharide conjugate vaccine against S. aureus infections in process. • The results of the phase 3 clinical trials of the vaccine (Staph VAX) will be presented 2006.
- 38. Future Prospects • What of the future? Many new avenues are under exploration. • Tea-tree oil in a nasal application together with a body wash was shown to be as effective as mupirocin with antiseptic washes in the eradication of carriage of MRSA • Antiseptic-coated endotracheal tubes are undergoing trials.
- 39. Cont… • Other techniques under investigation include a hydrogen-peroxide-based gas to decontaminate the environment, air filtration units and diagnostic kits, phage therapy and, perhaps the most interesting • A search of Medline yielded no published data on this last approach. Whatever new answers emerge, we must hope they will not go the way of methicillin.
- 40. MRSA- Indian Scenario • MRSA is endemic in India and is a dangerous pathogen for hospital acquired infections. • This study was conducted in Indian tertiary care centres during a two year period from January 2008 to December 2009 to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India.
- 41. Cont…. • In India first MRSA, 6th in world was isolated in 2005 at Kolkata from the cases of wounds in children. • Till than it has been reported from various part of country including animals and supposed to be major cause of mastitis in bovines (Kiran, 2014).
- 42. • National Guidelines for controlling MRSA were published in 1998 and are currently under revision. • A two-tier control programme was recommended.
- 43. References 1. http://www.niaid.nih.gov/topics/antimicrobialresistance/examples/mrsa/pages/default.aspx 2. Mitchell, David.MRSA.”what’s New”. Inoculum. Volume 8, number 2 (1999) 1-12. 3. textbookofbacteriology.net/resantimicrobial.htm 4. healthsciences.columbia.edu/ dept/ps/2007/mid/2006/transcript_02_mid22.pdf 5. http://www.bioteach.ubc.ca/Biodiversity/AttackOfTheSuperbugs 6. Foster, Timothy. The staphylococcus aureus “superbug”.J. clin Ivestigation 7. Volume number114 (2004) 1693-1696. 8. www.channing.harvard.edu/4a.htm 9. ww.ncbi.nlm.nih.gov. 10. www.aafp.org/afp/ 20000815/804.html 11. Journal of Clinical Microbiology, June 2000, p. 2378-2380, Vol. 38, No. 6 0095-1137/04.00+0 12. www.FDA.com (FDA archives) 13. www.postgradmed.com/issues/2001/10_01/hoel.htm 14. www.cdc.gov/ncidod/hip/aresist/mrsa_CDCactions.htm 15. www.medscape.com 16. http://www.nabi.com/images/factsheets/fsStaphVAX.pdf 17. http://textbookofbacteriology.net/staph_2.html 18. http://aic-server4.aic.cuhk.edu.hk/web8/0205_MRSA.jpg
- 44. Cont… 19. Duckworth G. Controlling methicillin-resistant Staphylococcus aureus. BMJ 2003;327: 1177–8[PMC free article] [PubMed] 20. Voss A. Preventing the spread of MRSA. BMJ 2004;329: 521. [PMC free article] [PubMed] 21. Thompson DS. Methicillin-resistant Staphylococcus aureus in a general intensive care unit. J R Soc Med2004;97: 521–6 [PMC free article] [PubMed] 22. Rolinson GL, Stevens S, Batchelor FR, Cameron Wood J, Chain EB. Bacteriological studies on a new penicillin. Lancet 1960;ii: 564–9 [PubMed] 23. Elek SD, Fleming PC. A new technique for the control of hospital cross infection. Lancet 1960;ii: 569– 72[PubMed] 24. Jevons MP. ‘Celbenin-resistant’ staphylococci. BMJ 1961;i: 124–5 25. Cox RA, Conquest C, Mallaghan C, Marples RR. A major outbreak of methicillin-resistant staphylococci caused by a new phage type (EMRSA-16). J Hosp Infect 1995;29: 87–106 [PubMed] 26. Farrington M, Redpath C, Trundle C, Coomber S, Brown NM. Winning the battle, but losing the war: methicillin- resistant Staphylococcus aureus (MRSA) at a teaching hospital. Q J Med 1998;91: 539–48[PubMed] 27. British Society for Antimicrobial Chemotherapy, Hospital Infection Society, Infection Control Nurses Association. Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. J Hosp Infect 1998;39: 253–90 [PubMed] 28. Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ETM. The Second National Prevalence Survey of Infection in Hospitals—overview of the results. J Hosp Infect 1996;32: 175–90 [PubMed] 29. Barrett SP, Mummery RV, Chattopadhyay. Trying to control MRSA causes more problems than it solves. J Hosp Infect 1998;39: 85–93 [PubMed] 30. Farrington M, Redpath C, Trundle C, Brown NM. Controlling MRSA. J Hosp Infect 1999;40: 251–4[PubMed] •
- 45. Cont… 31. Cooper BS, Stone SP, Kibbler CC, et al. Isolation measures in the hospital management of methicillin- resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004;329: 533–9[PMC free article] [PubMed] 32. Wertheim HFK, Vos MC, Boelens HAM, et al. Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of the search and destroy and restrictive antibiotic use. J Hosp Infect 2004;56: 321–5 [PubMed] 33. Marshall C, Wolfe R, Kossman T, Wesselingh S, Harrington G, Spelman D. Risk factors for acquisition of methicillin-resistant Staphylococcus aureus by trauma patients in the intensive care unit. J Hosp Infect2004;57: 245–52 [PubMed] 34. Silvestri L, van Saene HKF, Milanese M, et al. Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial. Eur Respir J 2004;23: 921–6 [PubMed] 35. de la Cal MA, Cerda E, van Saene HKF, et al. Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit. J Hosp Infect 2004;56: 175–83 [PubMed] 36. Van Saene HKF, Weir WI, de la Cal MA, Silvestri L, Petros AJ, Barrett SP. MRSA—time for a more pragmatic approach. J Hosp Infect 1998;56: 175–83 37. Howe R, Monk A, Wootton M, Wash T, Enright MC. Vancomycin susceptibility within methicillin- resistant Staphylococcus aureus lineages. Emerg Infect Dis 2004;10: 855–7 [PMC free article] [PubMed] 38. Dryden MS, Dailly S, Crouch M. A randomised, controlled trial of tea tree topical preparations versus a standard topical regime for the clearance of MRSA colonisation. J Hosp Infect 2004;56: 283–6 [PubMed] 39. Pancheco-Fowler V, Gaonakar T, Wyer PC, Modak K. Antiseptic impregnated endotracheal tubes for the prevention of bacterial colonisation. J Hosp Infect 2004;57: 170–4 [PubMed] 40. French GL, Otter J, Shannon KP, Adams NMT, Watling D, Parks MJ. Tackling hospital environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect (in press)[PubMed]