After surgery one of the most feared complications is an infection with MRSA. MRSA stands for methiciline resistant staphylococcus aureus. This specific form is resistant to most antibiotics. Treatment options are limited for patients infected with MRSA and complications often arise. We will talk about all it’s implications here.
Under normal circumstances staph aureus is a bacteria that resides on the skin, in the mucus of the nose and in the gut. About 30% of the population is a carrier of staph aureus and will most likely never get sick or infected. The skin forms a great barrier to protect one against staphylococcus Aureus. The bacteria itself isn’t completely harmless: it can produce toxines, adhesines, enzymes and escape elements. Just like most bacteria it can adapt itself to it’s surroundings. However a regular staph aureus is sensitive to antibiotics and it can be treated.
Problems arise when a patient carries a type of staph aureus that is resistant to antibiotics. This resistance comes from the bacteria itself which, as mentioned before, has the possibility to adapt itself to it’s surroundings. This forms a problem, because MRSA is resistant to the most used antibiotics, in fact there’s only one antibiotic left to use.
There is currently only one type of medication which is used to treat MRSA and that’s vancomycine given intravenously. It is the only medication used against MRSA (in Belgium), however it comes with quite a few side effects which is why we doctors might be reluctant to use it.
Side effects include:
-allergic reaction (fever, rash)
-tromboflebitis (on the site of the injection)
and there is of course risk that the bacteria adapts and becomes resistant to vancomycine.
Though vancomycine given intravenously provides a treatment option it’s recommended to use prevention strategies to avoid getting infected in the first place.
When it comes down to hospital setting everything will be ensured to make the patient as bacteria free as possible before surgery. This includes disinfecting the patient (washing the area before surgery as well as using disinfectant). Making sure that the surgeon and everyone in the operation room has scrubbed in. And giving the patient post operative antibiotics if necessary.
Operating rooms often have a lower temperature and the air is continuously filtered. All measurements to assure an aseptic environment.
Consequences of an infection
When someone has an open wound that is infected with MRSA, it can easily spread to other parts of the body. This can lead to infection of other organs, necrosis and septic shock. Because of the severity of these infections and the lack of alternative treatment options, MRSA is one of the most feared complications after surgery and most feared bacteria in the hospital hence why there are so many measures to prevent an infection with MRSA in any patient.
Should a patient be infected with MRSA the nurses and health care providers will make sure that they come in the room protected. Usually it’s not necessary for visitors to be protected though they are advised to disinfect their hands with soluble alcohol.
Special measurements will continue to be taken until the patient is free from MRSA.
Pictures: picture 1, Picture 2
Information: course “infectie en afweer’ taught by prof. dr. Bruno Verhasselt and prof. dr. Bart Vandekerckhove at the University of Ghent