Frequently Asked Questions for MRSA –
Methicillin-resistant Staphylococcus aureus
What inquiring minds what to know:
What is Staphylococcus aureus?
Staphylococcus aureus, often referred to simply as “staph,” are bacteria
commonly carried on the skin or in the nose of healthy people. Approximately
25% to 30% of the population is colonized – when bacteria is present, but not
causing an infection – in the nose with staph bacteria. Sometimes, staph can
cause an infection. Staph bacteria are one of the most common causes of skin
infections in the United States. Most of these skin infections are minor (such as
pimples and boils) and can be treated without antibiotics (also known as
antimicrobials or antibacterials). However, staph bacteria also can cause serious
infections (such as surgical wound infections, bloodstream infections, and
pneumonia).
What is MRSA – methicillin-resistant Staphylococcus aureus?
Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is
resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include
methicillin and other more common antibiotics such as oxacillin, penicillin and
amoxicillin. While 25% to 30% of the population is colonized with staph,
approximately 1% is colonized with MRSA.
MRSA by the numbers
$20 billion – Cost to treat MRSA each year
2 million – Number of people sick from MRSA in 2006
$600,000 – Annual hospital spending to screen for MRSA per site
92,000 – Number of people killed by hospital acquired infections – MRSA is the
leading cause
$10,000 – Average increased cost for MRSA hospital bills vs. traditional staph
90 – Maximum number of days MRSA has survived on polyethylene plastic in
clinical trials
36 - % increase of fatalities on MRSA over traditional staph
12 – Minutes MRSA can survive at boiling temperatures
10 – Percentage of MRSA patients who have return cases in 30 days
7 – Additional days a MRSA patient is hospitalized vs. staph
2 – Confirmed staph deaths in college football
Sources: Bloomberg News (9/27/06), WebMD (9/28/06), Chronicle of Higher Education (9/29/06),Journal of Clinical
Microbiology (2 00)
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Who gets staph or MRSA infections?
Staph infections, including MRSA, occur most frequently among persons in
hospitals and healthcare facilities (such as nursing homes and dialysis centers)
who have weakened immune systems. These healthcare-associated staph
infections include surgical wound infections, urinary tract infections, bloodstream
infections and pneumonia.
What is community-associated MRSA (CA-MRSA)?
Staph and MRSA can also cause illness in persons outside of hospitals and
healthcare facilities. MRSA infections that are acquired by persons who have not
been recently (within the past year) hospitalized nor had a medical procedure
(such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph
or MRSA infections in the community are usually manifested as skin infections,
such as pimples and boils, and occur in otherwise healthy people.
How common are staph and MRSA infections?
Staph bacteria are one of the most common causes of skin infection in the United
States and are a common cause of pneumonia, surgical wound infections, and
bloodstream infections. The majority of MRSA infections occur among patients
in hospitals or other healthcare settings; however, it is becoming more common
in the community setting. Data from a prospective study in 2003 suggests that
12% of clinical MRSA infections are community-associated, but this varies by
geographic region and population.
What does a staph or MRSA infection look like?
Staph bacteria, including MRSA, can cause skin infections that may look like a
pimple or boil and can be red, swollen, painful, or have pus and other drainage.
More serious infections may cause pneumonia, bloodstream infections, or
surgical wound infections.
What are the clinical features of CA-MRSA?
CA-MRSA most often presents as skin or soft tissue infection such as a boil or
abscess. Patients frequently recall a “spider bite.” The involved site is red,
swollen, and painful and may have pus or other drainage. Staph infections also
can cause more serious infections, such as bloodstream infections or
pneumonia, leading to symptoms or shortness of breath, fever, and chills.
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What are the criteria for distinguishing CA-MRSA from healthcare-associated
MRSA (HR-MRSA)?
Persons with MRSA infections that meet all the following criteria likely have CAMRSA infections:
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Diagnosis of MRSA was made in the outpatient setting or by a culture
positive for MRSA within 48 hours after admission to a hospital.
No medical history of MRSA infection or colonization.
No medical history in the past year of:
 Hospitalization
 Admission to a nursing home, skilled nursing facility, or hospice
 Dialysis
 Surgery
No permanent indwelling catheters or medical devices that pass through
the skin into the body.
How is a MRSA infection diagnosed?
In general, a culture should be obtained from the infection site and sent to the
microbiology laboratory. If S. aureus is isolated, the organism should be tested
as follows to determine which antibiotics will be effective for treating the infection.
Skin infection: Obtain either a small biopsy or drainage from the infected site. A
culture of a lesion is especially useful in recurrent or persistent cases of skin
infection, in cases of antibiotic failure, and in cases that present with advanced or
aggressive infections.
Pneumonia: Obtain a sputum culture (expectorated purulent sputum, respiratory
lavage, or bronchoscopy).
Bloodstream infection: Obtain blood cultures using aseptic techniques.
Urinary infection: Obtain urine cultures using aseptic techniques.
Are certain people at increased risk for community-associated staph or MRSA
infections?
CDC (Centers for Disease Control) has investigated clusters of CA-MRSA skin
infections among athletes, military recruits, children, Pacific Islanders, Alaskan
Natives, Native Americans, men who have sex with men, and prisoners.
Factors that have been associated with the spread of MRSA skin infections
include: close skin-to-skin contact, openings in the skin such as cuts or
abrasions, contaminated items and surfaces, crowded living conditions, and poor
hygiene.
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How can I prevent staph or MRSA skin infections?
Practice good hygiene:
1. Keep your hands clean by washing thoroughly with soap and water
or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with bandage until healed.
3. Avoid contact with other people’s wounds or bandages.
4. Avoid sharing personal items such as towels or razors.
Are people who are positive for the human immune deficiency virus (HIV) at
increased risk for MRSA? Should they be taking special precautions?
People with weakened immune systems, which include some patients with HIV
infection, may be at risk for more severe illness if they get infected with MRSA.
People with HIV should follow the same prevention measures as those without
HIV to prevent staph infections, including practice good hygiene, cover wounds
(e.g. cuts or abrasions) with clean dry bandages, avoid sharing personal items
such as towels and razors, and contact their doctor if they think they have an
infection.
Can I get a staph or MRSA infection at my health club?
In the outbreaks of MRSA, the environment has not played a significant role in
the transmission of MRSA. MRSA is transmitted most frequently by direct skinto-skin contact. You can protect yourself from infections by practicing good
hygiene (e.g. keeping your hands clean by washing with soap and water or using
an alcohol-based hand rub and showering after working out); covering any open
skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing
personal items such as towels or razors; using a barrier (e.g. clothing or a towel)
between your skin and shared equipment; and wiping down surfaces of
equipment before and after use.
What should I do if I think I have a staph or MRSA infection?
See your healthcare provider.
Are staph and MRSA infections treatable?
Yes. Most staph and MRSA infections are treatable with antibiotics. If you are
given an antibiotic, take all of the doses, even if the infection is getting better,
unless your doctor tells you to stop taking it. Do not share antibiotics with other
people or save unfinished antibiotics to use at another time.
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However, many staph skin infections may be treated by draining the abscess or
boil and may not require antibiotics. Drainage of skin boils or abscesses should
only be done by a healthcare provider.
If after visiting your healthcare provider the infection is not getting better after a
few days, contact them again. If other people you know or live with get the same
infection tell them to go to their healthcare provider.
Is it possible that my staph or MRSA skin infection will come back after it is
cured?
Yes. It is possible to have a staph or MRSA skin infection come back (recur)
after it is cured. To prevent this from happening, follow your healthcare
provider’s directions while you have the infection, and follow the prevention steps
after the infection is gone.
If I have a staph or MRSA skin infection what can I do to prevent others from
getting infected?
You can prevent spreading staph or MRSA skin infections to others by following
these steps:
1. Cover your wound. Keep wounds that are draining or have pus covered
with clean, dry bandages. Follow your healthcare provider’s instructions
on proper care of the wound. Pus from infected wounds can contain staph
or MRSA, so keeping the infection covered will help prevent the spread to
others. Bandages or tape can be discarded with the regular trash.
2. Clean your hands. You, your family, and others in close contact should
was their hands frequently with soap and warm water or use an alcoholbased hand sanitizer, especially after changing the bandage or touching
the infected wound.
3. Do not share personal items. Avoid sharing personal items such as
towels, washcloths, razors, clothing, or uniforms that may have had
contact with the infected wound or bandage. Wash sheets, towels, and
clothes that become soiled with water and laundry detergent. Drying
clothes in a hot dryer, rather than air-drying, also helps kill bacteria in
cloths.
4. Talk to your doctor. Tell any healthcare providers who treat you that you
have or had a staph or MRSA skin infection.
What should I do if someone has a staph or MRSA infection?
If you know someone that has a staph or MRSA infection you should follow the
prevention steps.
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Are MRSA infections a reportable disease?
MRSA is reportable in several states. The decision to make a particular disease
reportable to public health authorities is made by each state, based on the needs
of that individual state. MRSA is not a reportable disease in the Commonwealth
of Virginia. To find out if MRSA is reportable in another state, contact the state
health department.
Reference List – from CA-MRSA Information for the Public/Clinicians, a CDC
document
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Buckingham S, McDougal L, Cathey L;et al. Emergence of CommunityAssociated Methicillin-Resistant Staphylococcus aureus at a Memphis,
Tennessee Children's Hospital. Ped InfDis J. 23(7):619-624, 2004
Centers for Disease Control and Prevention. Community-acquired
methicillin-resistant Staphylococcus aureus infections—Michigan. MMWR.
1981; 30:185-7.
Centers for Disease Control and Prevention. Methicillin-resistant
Staphylococcus aureus skin or soft tissue infections in a state prison—
Mississippi, 2000. MMWR 2001; 50(42):919-22.
Centers for Disease Control and Prevention. Four pediatric deaths from
community-acquired methicillin-resistant Staphylococcus aureus —
Minnesota and North Dakota, 1997-1999. JAMA 1999; 282:1123-5.
Collignon P, Gosbell I, Vickery A, et al. Community-acquired methicillinresistant Staphylococcus aureus in Australia. Australian Group on
Antimicrobial Resistance. Lancet 1998; 352:145-6.
Embil J, Ramotar K, Romance L, et al. Methicillin-resistant
Staphylococcus aureus in tertiary care institutions on the Canadian
prairies 1990-1992. Infect Control Hosp Epidemiology 1994; 15:646-51.
Feder HM, Jr. Methicillin-resistant Staphylococcus aureus infections in 2
pediatric outpatients. Arch Fam Med 2000; 1163-6.
Frank AL, Marcinak JK, Mangat PD, Schreckenberger PC. Communityacquired and clindamycin-susceptible methicillin-resistant Staphylococcus
aureus in children. Ped Inf Dis J 1999; 18:993-1000.
Goetz A, Posey K, Fleming J, et al. Methicillin-resistant Staphylococcus
aureus in the community: a hospital-based study. Infect Control Hosp
Epidemiol 1999; 20:689-91.
Groos A, Naimi T, Wolset D, Smith-Johnson K, Moore K, Cheek J.
Emergence of community-acquired methicillin-resistant Staphylococcus
aureus in a rural American Indian community (Abstract 1230), 39th Annual
Interscience Conference on Antimicrobial Agents and Chemotherapy, San
Francisco, CA, 1999.
Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired
methicillin-resistant Staphylococcus aureus in children with no identified
predisposing risk. JAMA 1998; 279:593-8.
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Hussain FM, Boyle-Vavra S, Bethel CD, Daum RS. Current trends in
community-acquired methicillin-resistant Staphylococcus aureus at a
tertiary care pediatric facility. Ped Inf Dis J 2000; 19:1163-6.
Kallen AJ, Driscoll TJ, Thornton S, Olson PE, Wallace MR. Increase in
community-acquired methicillin-resistant Staphylococcus aureus at a
Naval Medical Center. Inf Cont Hosp Epi 2000; 21:223-6.
Kazakova SV, Hageman JC, Matava M, et al. A Clone of MethicillinResistant Staphylococcus aureus among Professional Football Player N
Engl J Med 2005; 352.
Lindenmayer JM, Schoenfeld S, O’Grady R, Carney JK. Methicillinresistant Staphylococcus aureus in a high school wrestling team and the
surrounding community. Arch Int Med 1998; 158:895-9.
Maguire GP, Arthur AD, Boustead PJ, Dwyer B, Currie BJ. Emerging
epidemic of community-acquired methicillin-resistant Staphylococcus
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Martinez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason
EO Jr, Kaplan SL. Community-acquired, methicillin-resistant and
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in children Ped Inf Dis J. 2004;23(8):701-6.
Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of Communityand Health Care-Associated Methicillin-Resistant Staphylococcus aureus
Infection. JAMA 2003 290(22):2976-2984.
Price MF, McBride ME, Wolf JE, Jr., Prevalence of methicillin-resistant
Staphylococcus aureus in a dermatology outpatient population. South Med
J 1998:91:369-71.
Rings T, Findlay R, Lang S. Ethnicity and methicillin-resistant S. aureus in
South Auckland. N Zeal Med J 1998; 111:151.
Saravolatz LD, Markowitz N, Arking L, Pohloh D, Fisher E. Methicillinresistant Staphylococcus aureus . Epidemiologic observations during a
community-acquired outbreak. Ann Intern Med. 1982; 96:11-16.
Stacey AR, Endersby KE, Chan PC, Marples RR. An outbreak of
methicillin- resistant Staphylococcus aureus infection in a rugby football
team. Br J Sports Med 1998; 332: 53-4.
All of the information for this document was compiled from various resources of the
CDC. For more information on this topic or other topics you can find the CDC online at
www.cdc.gov.
Information about MRSA not being a reportable disease in the Commonwealth of
Virginia was obtained via a phone conversation with the Fredericksburg City Health
Department, 540-899-4142, located at 608 Jackson Street, Fredericksburg, VA, 22401.
This document was medically updated February 5, 2016.
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