Is it really MRSA?

Editorial Team / Admin · Jul 4, 2013

Thank you! I was really biting my tongue (fingers?) over that one.

Double-Helix, BSN, RN · Jul 4, 2013

Thanks for posting this. There is a lot of misinformation about MRSA, even among healthcare providers. In our ICU we do a nasal swab to test for MRSA first and, if positive, the patient is treated with Bactroban to the nares twice daily for 5 days and then re-tested.

I think the reason we don't just treat everyone is because kids generally get very PO's when you try to stick stuff in their nose.

RLtinker, LPN · Jul 4, 2013

I actually had a long post lined up for that thread and then it was closed before I could post. :wideyed: Anyway there are a number of resources out there including the CDC.

CDC - Methicillin-resistant Staphylococcus Aureus (MRSA) Infections

Sometimes it seems like people are either completely scared of it or completely ignore it all together.

MunoRN, RN · Jul 4, 2013

I lifted this quote from a closed thread to clarify a point made (which was not related to the reason it was closed).
" First, you don't find "MRSA" in the stomach, well you sort of do in that all enterococci are resistant to the methicillin family, but it's not the same as "MRSA". Everyone is colonized with bacteria, and if some of that bacteria is resistant to methicillin antibiotics then we call it MRSA, but that doesn't mean that someone is oozing MRSA out of every possible place in their body, and it's actually usually localized; in a wound, in the sputum, in skin folds, etc. MRSA infections are treated, simple colonizations or getting some MRSA on you, or even in your eyes, should not be treated with antibiotics."
MRSA stands for "methicillin-resistant Staphylococcus aureus," and not anything else. An enterococcus is not a staphylococcus. We don't call anything that's methicillin-resistant "MRSA." Calling anything that's resistant to methicillin "MRSA" is inaccurate and misleading, and bespeaks an indication to go back to your micro textbook for a refresher. Here's a good article that also clarifies what's infection and what's colonization, and how that works specifically in people with MRSA.

I thought the "but it's not the same as MRSA" statement of that post was pretty clear.

You'll notice I specifically distinguished "enterococci" from staph aureus. I only clarified that MRSA and enterococci aren't completely different in that enterococci are typically also resistant to methicillin.

Furthermore, recent research indicates that swabbing nares with mupirocin (Bactroban) for every patient in the ICU, without regard to whether cultures were done or not, reduced the number of MRSA infections in the unit as a whole. So yes, prophylaxis is becoming standard in those settings.

Blanket treatment of MRSA colonization in the general population is definitely not the standard, which is what I was referring to (that should have been fairly obvious as the person in question was clearly not hospitalized), the CDC's position is still that the risks of comprehensive treatment of MRSA colonization (creating even more resistant bacteria) doesn't outweigh any potential benefits. In some "at risk" small subgroups, there may be some advantage but it has by no means risen to level of a standard.

The study you're referring to, the recent HCA study, was a bit faulty in that it looked at the effect of both daily CHG bathing and nasal decolonization, making it difficult to isolate the effects of each and we already know CHG baths reduce infection. Even so, routine decolonization of OHS and ICU patients is not a comprehensive decolonization, it is a temporary decolonization in a very specific and small subgroup of the population at high risk for developing pneumonia. There has been no studies or recommendations that advise everyone who is colonized with MRSA be decolonized.

RainMom · Jul 4, 2013

Furthermore, recent research indicates that swabbing nares with mupirocin (Bactroban) for every patient in the ICU, without regard to whether cultures were done or not, reduced the number of MRSA infections in the unit as a whole. So yes, prophylaxis is becoming standard in those settings.

Just thought this was very interesting as it relates to something my father had preached to me most of my life. My little brother had to have an umbilical hernia repair when he was a baby & developed a staph infection. It was cleared up & then he had a 2nd one. Us kids had our throats swabbed, while Mom & Dad's nares were swabbed. Turns out, Dad was a carrier. This was 30+ yrs ago, so whether it was determined to be MRSA or just plain old staph. aureus, I don't know. But my Dad was instructed to swab his nose daily for a period of time with mycitracin.

After that, Dad continued to swab his nose once every week or two. I don't recall him being sick a day in his life. Several years ago when there were some staph outbreaks (I believe out west?) making national news, Dad would call & insist that everyone swab their nose with triple antibiotic. Now working in a hospital & the inevitable MRSA pts, at times I have thought perhaps I need to swab myself!

finn55 · Jul 5, 2013

I contracted MRSA after fracturing my right femur. It was a closed fracture, but, without hesitation, everyone I asked where I contracted the infection said, "the hospital". I had five surgeries at the same facility: one to place the plate and screws, three to clean out the infection, and one to remove the plate and screws. I was on IV Vancomycin, and developed a beautiful 'red man's syndrome'. I was in an extended care facility from March until mid-August. Was ambulatory with a walker, but the osteomyelitis returned. To make this story short, I ended up at a major medical center for a transfemoral amputation of my right leg. Subsequent nasal-pharyngeal swabs have indicated a colonization of MRSA. What upset me the most, was being treated like a 'rotten piece of meat.' I think medicine, AND nursing needs to do more to support patients emotionally when they are going through this type of process. As a nurse myself, I knew probably what needed to be done, but I very much needed some more TLC to get through this situation.

siRNita, BSN, RN · Jul 5, 2013

Finn55, sorry to hear about your health struggles. That sounds like a terrible series of events. I'm sorry that you weren't treated with all the kindness and compassion you deserved. I hope you'll use your experiences to educate us on what works in therapeutic communication. Thanks for sharing and reminding us that MRSA (often ignored as another familiar hospital acronym) is not something to take lightly.

nurseprnRN, BSN, RN · Jul 5, 2013

I thought the "but it's not the same as MRSA" statement of that post was pretty clear.

You'll notice I specifically distinguished "enterococci" from staph aureus. I only clarified that MRSA and enterococci aren't completely different in that enterococci are typically also resistant to methicillin.

I was referring to this:

"Everyone is colonized with bacteria, and if some of that bacteria is resistant to methicillin antibiotics then we call it MRSA, but that doesn't mean that someone is oozing MRSA out of every possible place in their body, and it's actually usually localized; in a wound, in the sputum, in skin folds, etc."

Wrong-o. Not all bacteria are Staphylococcus. Sorry I didn't make that clearer.

MunoRN, RN · Jul 5, 2013

I was referring to this:
"Everyone is colonized with bacteria, and if some of that bacteria is resistant to methicillin antibiotics then we call it MRSA, but that doesn't mean that someone is oozing MRSA out of every possible place in their body, and it's actually usually localized; in a wound, in the sputum, in skin folds, etc."
Wrong-o. Not all bacteria are Staphylococcus. Sorry I didn't make that clearer.

Yes, that was bad editing on my part. It initially read "Many people are colonized with staph a, and if some of that bacteria... I then decided I didn't want to give the OP in the other thread the impression that those who are not SA colonized are otherwise sterile, so I changed the first part of that and then neglected to change the second part, my bad.

Although it would seem that the other statement specifically declaring that not all bacteria resistant to methicillin are MRSA would have helped you realize I didn't believe that all bacteria resistant to methicillin are MRSA, it seems like to bent over backwards to ignore that actually.

FineAgain · Jul 6, 2013

Out of curiosity...our hospital, once you test positive for MRSA or VRE, you are always considered positive. I know that not all hospitals do this, and I think it might be expensive and redundant. What do you all think? When my Dad was positive for both, the hospital (many states away from mine) policy there was that if you had 3 (weekly I think) negatives, you were considered "clear".

Very interesting also, about the prophylactic treatment. I don't think we are doing that but you can bet I will be asking our Infection Control...

S.G. · Jul 6, 2013

Out of curiosity...our hospital once you test positive for MRSA or VRE, you are always considered positive. I know that not all hospitals do this, and I think it might be expensive and redundant. What do you all think?[/quote']
If we had someone listed as positive for MRSA on their last visit, they're put on precautions and we do a nasal swab. The precautions are taken down if the swab is negative. We swab everyone coming in for any surgery or procedure and everyone with a history of MRSA.