Staphylococcus aureus (S. aureus) is a bacterium commonly carried on the skin or in the nasal cavity of healthy people. These healthy individuals carry the bacteria without signs or symptoms of infection. Yet, the bacteria may sometimes cause diseases such as infection of skin, wound, urinary tract, lung, bloodstream and food poisoning.
Most S. aureus infections can be treated by antibiotics effectively. However, methicillin-resistant S. aureus (MRSA) is a strain of S. aureus that is resistant to antibiotics including methicillin and other commonly used antibiotics such as oxacillin, penicillin, amoxicillin and cephalosporins. Improper use of antibiotics is widely recognised as a contributing factor to antibiotic resistance.
Most MRSA infections occur in people who have been hospitalised, live in residential care homes or have received treatment in health care settings such as dialysis centres. However, infections can also occur in community-dwelling individuals who have not been hospitalised, stayed in residential care homes, or received medical procedures within a year prior to symptom onset. These are known as community-associated MRSA (CA-MRSA) infections.
CA-MRSA usually causes skin and soft tissue infections such as pimples, boils, abscesses or wound infections. The infected area may be red, swollen and painful or it may produce pus. Sometimes, more serious sequelae such as bloodstream infections, lung infections or necrotising fasciitis may occur.
Mode of transmission
The main mode of transmission of CA-MRSA infections is through direct contact with wounds, discharge and soiled areas. Other risk factors include close contact, presence of skin lesions such as cuts or abrasions, contact with soiled items, poor personal hygiene and crowded living conditions.
Individuals with wound infection should seek advice from healthcare professional quickly so that the infection can be properly diagnosed and effectively treated. Boils or abscesses may require incision and drainage and antibiotics may be prescribed if indicated. For patients with confirmed CA-MRSA infection, doctors may offer decolonization therapy (please refer to “Decolonization therapy” below) as appropriate (e.g. if no contraindication).
The decolonization therapy contains the following two medications for external use:
1. 4% chlorhexidine gluconate liquid soap (Hibiscrub or other product containing the same active ingredient)
Apply daily as liquid soap to whole body for 5 days, and as a shampoo to hair and scalp on days 1, 3 and 5. Leave for ONE minute before rinsing.
2. 2% mupirocin nasal ointment (Bactroban or other product containing the same active ingredient)
Three times daily application for 5 days into anterior nares of both nostrils.
In general, decolonization therapy should be started after the skin and soft tissue infection has resolved. Decolonization medications are for external use only and are not routinely recommended for children under 12 years of age.
The following measures may help protect against CA-MRSA infections:
1. Maintain personal hygiene
2. Proper wound management
3. Safe use of antibiotics
4. Maintain environmental hygiene
Methicillin-resistant Staphylococcus Aureus (MRSA) Infection and Community-associated MRSA Infection (Pamphlet):
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