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).
CA-MRSA patients and their close contacts (e.g. household contacts, boy/girlfriend, carer, etc.) should receive the following topical decolonization therapy (if there is no any contraindication):
1. 4% chlorhexidine gluconate liquid soap (Hibiscrub or other liquid soap containing the same active ingredient)
Method of use: Apply to whole body, hair and scalp and leave for ONE minute before rinsing.
2. 10% povidone-iodine ointment (Betadine or other ointment containing the same active ingredient)
Method of use: Apply small amount of the ointment (about the size of a match head) to the inner surface of one nostril (anterior nare). Repeat the same for the other nostril. The nostrils are then closed by pressing the sides of the nose together using the thumb and the index finger. This can spread the ointment inside the nares. A swab may be used to assist the application of the ointment. The patient may feel the taste the ointment at the nasopharynx or back of the throat after application, which is normal.
Information for Patients with Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Infection and their close contacts
The following measures may help protect against CA-MRSA infections:
1. Maintain good personal hygiene
2. Proper wound management
3. Proper use of antibiotics
4. Maintain good environmental hygiene
Methicillin-resistant Staphylococcus Aureus (MRSA) Infection and Community-associated MRSA Infection (Pamphlet):
Bahasa Indonesia Version