The Many Faces of MRSA: Community-Acquired Infection Knows No Bounds

Annals of Emergency Medicine:

A Breeding Ground?

Jevons’ finding ushered in several decades in which methicillin-resistant staph became a feared nosocomial pathogen. It sparked ferocious outbreaks in critical care units: In 1980, in just one example, a burn patient transferred to Harborview Medical Center in Seattle transmitted MRSA to 34 other patients in 15 months despite the staff’s best efforts at infection control, and 17 of the patients died.3 That outbreak also signaled how formidably resistant the hospital strain of staph would become: the original patient’s isolate was resistant to quinolones, clindamycin, erythromycin, trimethoprim, and gentamicin in addition to the beta-lactams.

The new prevalence of CA-MRSA poses additional challenges for ED staff. Hospital-acquired-MRSA became endemic in hospitals through simple failures in infection control; several studies in the past decade have demonstrated that EDs’ record of hand-washing is poor.34, 35, 36 The risks of poor hygiene in an ED are likely to be exacerbated not only by ED stress and crowding, but also by MRSA’s known ability to remain viable on hospital surfaces—in one study, for more than 12 days.37

And if EDs become amplifiers of CA-MRSA, it may not only be patients who are at risk. Last year, a Garland, TX firefighter and emergency medical technician died of invasive MRSA,38 and a Troy, NY firefighter/EMT was temporarily disabled by extensive soft tissue infection.39 In 2005, this journal carried a report of an emergency medicine resident with recurrent MRSA infection that might have been occupationally acquired.40

CA-MRSA “is here to stay,” Moran said, who hopes to repeat the EmergencyID Net study this year to see whether prevalence continues to increase or has plateaued. “It has become the new normal. There is something about these strains that gives them a survival advantage, and I don’t think we will see that go away.”

What happens when an infant gets a staph infection in the hospital that is resistant to drugs?