Mrsa

MRSA do not cause any specific clinical pictures (see below Staphylococci), but they are increasingly colonising the leg ulcer and are thus gaining in importance. MRSA can occur without clinical symptoms as a colonising germ on the nasal and pharyngeal mucosa and the skin. This creates germ reservoirs that can infect immunodeficient patients in particular.

HA-MRSA (Hospital-acquired MRSA) refers to germ colonisations among hospital staff. They are of particular importance because of the continuous risk of infection for patients with immune deficiency, open wounds, dialysis, intravascular catheters or artificial respiration. Therefore, colonized patients must be identified early, isolated, and sanitized if possible.

CA-MRSA is the acronym for "community-associated" MRSA . CA-MRSA are to be distinguished from HA-MRSA (Hospital-acquired MRSA) and lead to infections within a group of people who are not in direct contact with health care facilities (e.g. hospitals). CA-MRSA have a different genetic background than HA-MRSA (Chambers et al 2009). In addition, CA-MRSA have divergent resistance profiles to antibiotic agents compared to HA-MRSA.

LA-MRSA: LA-MRSA is the acronym for "Livestock-associated MRSA" and refers to MRSA species associated with conventional animal fattening. This includes humans in close working contact with these animals (especially pigs, but also cattle for fattening and poultry for fattening) (Layer et al. 2012). In horse husbandry, for example, CA-MRSA, on the other hand, appear to be primarily a problem.

LA-MRSA plays a particular role for the following animal species:

• LA-MRSA in pigs
• LA-MRSA in poultry
• LA-MRSA in ruminants
• LA-MRSA in domestic animals
• LA-MRSA in horses

Colonisations are decontaminated locally (skin: washings e.g. with octenidine, chlorhexidine, polihexanide.

Decontamination over at least 5 days, see DEGAM S1 treatment recommendation!

Nose: Mupirocin ointment 3x / day for 5-6 days (Cave: increasing resistance to Mupiricin (Turixin®).

Oral hygiene and treatment of oral care and tooth brushing utensils or dentures with an
antiseptic suitablefor the
oral mucosa (e.g. Octenidol® solution).
1 x daily disinfection of skin and hair, i.e. showering or full body care incl. hair washing with a suitable
disinfecting wash lotion 3 x daily (e.g. Octenisan® wash lotion).

Antibiotic therapy is only indicated in clinically manifest diseases. In clinically relevant infections, glycopeptides ( vancomycin or teicoplanin), linezolid, tigecycline, daptomycin and, with restrictions, reserve antibiotics such as fusidic acid (Fucidine), fosfomycin (Infectofos) or rifampicin (Rifa) are effective.

Unfortunately, the care products cannot be prescribed at the moment. Control smear 48 hours after completion of the sanitation measures.

At the same time, it is essential to sanitize the articles in use:

- Disinfection of all objects in contact with skin or mucous membrane:
cleantoothbrush
anddentures with Octenidol® solution
and insert. Objects in use such as combs or hearing aids can be thoroughly
wipedwith pre-soaked disposable cloths.
It may be possible to use disposable products for some utensils during the eradication period
.
Wipe disinfection of the environment in contact with the hands (practically with pre-soaked disposable wipes) or cover
daily exchange/disinfection of the cover.

- Change of towels and washcloths immediately after use. Daily change of bed and body linen. Wash linen and
all utensils with disinfectant.

- Frequent hand disinfection: patient before leaving home, before social contacts, all contacts.

Ready-to-use kits: e.g. Braun Prontoderm® MRSA Kit Cleaning Set 1 Set, OCTENISAN® Set Washing Lotion+Nose Gel

Isolate patients: single room or cohort isolation, identify room.

When entering the room, wear extra protective gown which remains in the room. Change after 24 hours at the latest.

Wear protective gloves and mouth protection when handling patients.

Disinfect hands before leaving the room.

Personnel: if possible, patient-related care

Guard patients: educate, disinfect hands before leaving the room.

Transport of the patient: if possible on a stretcher or in bed; mouth protection; in case of wound infection cover the wound with a bandage, in case of urinary tract infection put on a diaper impermeable to moisture.

If transferred: inform the ward or hospital.

Mupirocin nasal ointment (Turixin ointment) if MRSA is detected in the anterior nasal cavity.

Whole body washings (e.g. chlorhexidine, polihexanide) if Staph. aureus colonisation of the skin is detected (patient and staff).

1. Chambers HF et al. (2009) Waves of resistance: Staphylococcus aureus in the antibiotic era. Nature reviews. Microbiology 7: 629-641.
2. Cohen PR (2005). Cutaneous community-acquired methicillin-resistant Staphylococcus aureus infection in participants of athletic activities. Southern medical journal 98: 596-602.
3. Kouyos R et al.(2013) Hospital-Community Interactions Foster Coexistence between Methicillin-Resistant Strains of Staphylococcus aureus. PLoS pathogens 9, e1003134.
4. Layer F et al.(2012) Current data and trends on methicillin-resistant Staphylococcus aureus (MRSA)]. Bundesgesundheitsblatt Gesundheitsforschung, Gesundheitsschutz 55: 1377-1386.
5. Maisch T et al. (2011) Photodynamic inactivation of multidrug-resistant bacteria (PIB) - a new approach to treat superficial infections in the 21st century. JDDG 9: 360-367
6. Fassbender B et al.(2013) Degam guidelines: MRSA - a handout for general practitioners part 2: therapy/remediation- https://www.degam.de/files/Inhalte/Leitlinien-Inhalte/Dokumente/DEGAM-S1-Handlungsempfehlung/053-034%20MRSA/S1-HE_MRSA_Therapie_Kurzfassung.pdf