MRSA
Transcript of MRSA
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JAYSHREEPh.D SCHOLAR
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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
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Virulence Determinants of Staphylococcus aureus
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Frequency of Staphylococcus aureuscolonization in carriers on various body sites
Nose 100%
Skin chest 45%
Perineum 60%Ankle 10%
Axilla 19%
Hand 90%
Forearm 45%
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S. aureus – as pathogen
• virulent factors (toxins and enzymes)
• Frequent nosocomial- and community-acquired pathogen
• Mode of transmission –contact
• Clinical manifestations1/31/2015 5
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Superficial Infections
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Scalded Skin Syndrome: Classic Toxic Shock
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Systemic Menstrual Toxic Shock
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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
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Cont…
• In the 1940s, medical treatment for S.aureus infections became routine asPenicillin was introduced as drug of choice.
• Penicillin- bacterial cell wall synthesis- inflow
of water- cell burst
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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
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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.
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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.
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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
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•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?
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How “Tough” is MRSA?
• Staphylococci can survive many extremeenvironmental conditions.
• The bacteria can be cultured from dried clinicalmaterial after several months, are relatively heatresistant, and can tolerate high salt media.
So, “What Do we Do?”
• You can not get rid of MRSA; you can onlycontrol it.
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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
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CA-MRSA and HA-MRSA
CA-MRSAUniquemicrobiologic andgenetic propertiescompared withHA-MRSA mayallow thecommunity strainsto spread moreeasily or causemore skin disease
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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
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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.
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Hospital-acquired MRSA (HA-MRSA)
HA-MRSA Healthcare-acquired Methicillin resistant Staph. aureus
Many hospitals now seeing CA-MRSA in healthcare associated infections
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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).
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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).
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Drugs against MRSA
• Daptomycin
• Linezolid(belonging to oxazolidiones class)
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Drugs In Development
• Oritavancin-Binds to normal cell wall
precursors
• Tigecyclin-Works on efflux pumps
• Dalbavancin- Bacteriacidal
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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
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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.
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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.).
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Cont…..
• Methicillin-Resistant Staphylococcus aureus
(MRSA) as the causal agent of nosocomial
infection demands a quick and trustworthy
characterization of isolates
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Phenotypic Methods
• Antibiogram typing
• Phage typing
• Serotyping
• Biotyping
• Protein electrophoretic typing
Whole cell protein typing
Immunoblotting
Zymotyping
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Genotypic Methods
• Plasmid DNA analysis
• Chromosomal DNA analysis
• Southern blot analysis of RFLP
• Ribotyping
• Binary typing
• Pulsed field gel electrophoresis
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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.
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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.
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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.
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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
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Vaccination
• Development of StaphVAX®, apolysaccharide conjugate vaccine against S.aureus infections in process.
• The results of the phase 3 clinical trials of thevaccine (Staph VAX) will be presented 2006.
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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.
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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.
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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.
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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).
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• National Guidelines for controlling MRSA
were published in 1998 and are currently under
revision.
• A two-tier control programme was
recommended.
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Cont…
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