Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are strains that cause fatal infections of the skin and soft tissues. The CA-MRSA form a strong resistance characteristic due to its combination of low fitness cost methicillin resistance and a high virulence (Otto, 2012, p. 1). In its resistance process, Staphylococcus aureus usually acquires a nonnative gene that encodes a penicillin-binding protein (PBP2a) whose affinity for β-lactams is substantially low (Figueiredo, 2017). The outcome of this acquisition is the ability of the strains to maintain cell-wall biosynthesis, which is usually a target of β-lactams. The biosynthesis persists in the presence of a high concentration of antibiotics that would typically inhibit the activities of the strain (Peacock & Paterson, 2015, p. 1).
In the United States, the 2004 to 2005 period had a total of 8987 cases of MRSA in only nine communities. 26.6 percent of the cases were CA-MRSA with a mortality rate of 6.3 per 100,000 (Klevens, 2007). The United States Centers for Disease Control and Prevention recorded 31.8 cases per 100,000, which amounted to 94,360 cases of the infection per annum in 2005 (David & Daum, 2010). In Asia and the Pacific region, 152 studies conducted between 2000 and 2016 show a prevalence rate of 0% to 23.5% in the general public. The most affected countries were India, with a prevalence of 16.5%–23.5%, Vietnam, with a rate of 7.9 %, and Taiwan at 3.7% (Wong et al., 2018).
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Contributing factors
Contributing factors of this strain are best discussed with specific affected populations. In some of the affected people, infections are linked to culture, socioeconomic status, environmental, and behavioral factors. However, some communities show no common risk factor among the affected individuals. Groups that have shown to harbor a common contributing factor are neonates, athletes, households, urban underserved persons, indigenous communities, prisoners, military personnel, men who have sex with men, persons living with HIV, and veterinarians.
In neonatal outbreaks, cases of MRSA were previously healthcare-associated and originated within the neonatal intensive care units. The scenario changed with the discovery of the CA-MRSA with reports indicating that the community-associated strain was infecting hospital setups. The contributing factor among cases in neonatal include infections from visiting family members, maternal mastitis, and peripartum maternal MRSA infections. Infections in athletes cut across several multidiscipline from junior levels to professional levels. The main factor contributing to the spread of the strain among athletes and military personnel are highly related. They include the sharing of items such as kits, uniforms, sporting accessories, military equipment, and toiletries. There is also a factor of poor hygiene in athletes' changing rooms, thus contributing to the spread of the strain. One peculiar study identified a higher body mass index as a contributing factor to CA-MRSA among high school athletes (David & Daum, 2010). Sexual activities and skin contacts are factors among households, prisoners, heterosexual, and men who have sex with men. A low socioeconomic class explains the transmission of the strain among the underserved urban group and the indigenous communities. The socioeconomic factor links to the indirect elements of poor hygiene and the sharing of personal effects. Infections among persons living with HIV are due to their susceptible immunity, while veterinarians are often infected by contact with pets, livestock, and birds, which are carriers of MRSA (David & Daum, 2010).
Prevention Strategies
The three most successful prevention methods are the use of chlorhexidine gluconate (CHG), mupirocin, and retapamulin. CHG is an effective antiseptic used in healthcare setup. The antiseptic is bactericidal for MRSA, but its continuous use may develop resistance in gram-negative bacteria. It's recommended that an alternating rotational method with other disinfectants be validated and applied. CHG is recommended for surgical bathing and use among persons with recurring infections. Mupirocin is used in the decolonization of patients and has shown to decreases post-surgical infections in patients colonized with MRSA. Lastly is the retapamulin antibiotic, which has low susceptibility to cross-resistance and has proven its effectiveness against strains of MRSA (Kong, Johnson, & Jabra-Rizk, 2016).
Symptoms and Diagnostic Tests
CA-MRSA strain affects the skin and soft tissues. Infections and symptoms associated with the strain include diarrhea, shock, necrotizing pneumonia, and fasciitis. Brain abscess, meningitis, septic thrombophlebitis, and septic arthritis are also common. Upon the observation of symptoms of CA-MRSA in persons under high risk, samples from body tissues or nasal fluids are extracted for laboratory analysis. The laboratory analysis involves incubation of samples in a pre-sterilized nutrient agar alongside a positive control and negative control in separate nutrient media. After 48 hours of incubation, the presence of CA-MRSA is determined by a growth similar to that of the positive control. Modern laboratory techniques use DNA staph method where the presence of the strain is detected with hours (Tenover et al., 2006).
Advanced Practice Nursing Role and Management Strategies
Nursing roles and management strategies of CA-MRSA are enshrined within health care settings as professional guidelines or state regulations. Such guidelines elaborate prevention measures and control strategies in affected communities. Prevention measures include routine environmental disinfection of high-risk areas and educating high-risk persons on different modes through which the strain is contracted. Control measures include isolation of infected persons, and identification and decolonization of carriers (Uhlemann et al., 2013).
Pharmacological Management and Follow-Up Care
The most recent medical solutions for CA-MRSA are ceftobiprole and ceftaroline. The two sets of drugs, grouped under cephalosporins, have a higher affinity for PBP2a than other β-lactam drugs (McClure, Shideler, & Zhang, 2019). Incision and drainage are also preferred in small uncomplicated cases but may be used along with other antimicrobial therapies. Conventional therapies used include a combination of trimethoprim and sulfamethoxazole, doxycycline, clindamycin, and minocycline. The use of linezolid as oral therapy is also successful when prescribed for an extended period (Pfaller, Sader, Rhomberg, Flamm, & Mendes, 2019). CA-MRSA is known to have a recurring characteristic among persons with a previous history of infection. Screening of high-risk persons is recommended, and decolonization conducted to avert frequent recurrences (NeVille-Swensen & Clayton, 2011).
Conclusion
CA-MRSA strain causes skin and soft tissue infections as its significant symptoms. CA-MRSA infections are globally spread with a United States prevalence rate at 31.8 cases per 100,000 in 2005. Factors leading to the spread of the strain are more pronounced in high-risk groups such as neonatal, prisons, military, and sporting teams. CHG, mupirocin, and retapamulin remain the most efficient antiseptics capable of preventing the spread of CA-MRSA in the community. On suspicion of infection among high-risk individuals, laboratory bioburden or DNA tests are conducted to identify and quantify the strain. Medical management procedures of the infected persons include incision and drainage, as well as the use of antimicrobial therapies such as trimethoprim and sulfamethoxazole.
References
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