Methicillin-resistant Staphylococcus aureus (MRSA) was one of the first organisms which highlighted the dangers of hospital-acquired infections.

Risk Factors

• Healthcare Exposure:
  • Recent hospitalisation or long inpatient stay
  • Admission to intensive care units (ICU) ; receiving mechanical ventilation in conjunction with pneumonia;
  • Residence in nursing homes or long-term care facilities
  • Recent surgery or invasive procedures such as ventricular shunting or ventriculostomy
  • Presence of indwelling devices (e.g., catheters, central lines, ventilators)
• Antibiotic Use:
  • Recent or prolonged use of broad-spectrum antibiotics, especially fluoroquinolones (e.g., ciprofloxacin), cephalosporins, and carbapenems
  • Repeated antibiotic courses
• Patient Factors:
  • A primary diagnosis of respiratory or digestive tract disease
  • Immunosuppression (e.g., chemotherapy, HIV infection, corticosteroid therapy)
  • Chronic illnesses such as diabetes mellitus, chronic kidney disease, or malignancy
  • Skin barrier disruption (eczema, wounds, ulcers, burns, injury/trauma)
  • Peripheral vascular disease
  • History of previous MRSA colonisation or infection
• Environmental and Social Factors:
  • Close contact with MRSA carriers or infected individuals
  • Poor hygiene or overcrowded living conditions
  • Participation in contact sports or sharing personal items
• Other Factors:
  • Use of invasive devices such as prosthetic joints or cardiac devices
  • Frequent healthcare worker contact without adequate infection control measures

Who should be screened for MRSA?

• all patients awaiting elective admissions (exceptions include day patients having terminations of pregnancy and ophthalmic surgery. Patients admitted to mental health trusts are also excluded)
• from 2011 all emergency admissions will be screened

How should a patient be screened for MRSA?

• nasal swab and skin lesions or wounds
• the swab should be wiped around the inside rim of a patient's nose for 5 seconds
• the microbiology form must be labelled 'MRSA screen'

Suppression of MRSA from a carrier once identified

• nose: mupirocin 2% in white soft paraffin, tds for 5 days
• skin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum

The following antibiotics are commonly used in the treatment of MRSA infections:

• vancomycin