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Methicillin-resistant staphylococcus aureus

MRSA (meticillin-resistant staphylococcus aureusis) a type of bacterial infection that is resistant to a number of widely used antibiotics.

MRSA is a type of bacterial infection that is resistant to a number of widely used antibiotics. This means it can be more difficult to treat than other bacterial infections. 

The full name of MRSA is meticillin-resistant staphylococcus aureus. You may have heard it called a superbug.

Staphylococcus aureus (also known as staph) is a common type of bacteria. It is often carried on the skin and inside the nostrils and throat, and can cause mild infections of the skin such as boils and impetigo.

If staph bacteria get into a break in the skin, they can cause life-threatening infections, such as blood poisoning or endocarditis (an infection of the inner lining of the heart).

Read more about the symptoms of a staph infection.

How bacteria become resistant to antibiotics

Antibiotic resistance can occur in several ways.

Strains of bacteria can mutate and over time become resistant to a specific antibiotic.

Alternatively, if you are treated with an antibiotic, it can destroy many of the harmless strains of bacteria that live in and on the body. This allows resistant bacteria to quickly multiply and take their place.

The overuse of antibiotics in recent years has played a major part in antibiotic resistance and superbugs. This includes using antibiotics to treat minor conditions that would have got better anyway and not finishing a recommended course of antibiotics.

How do you get MRSA?

MRSA infections are more common in people who are in hospital or nursing homes. Doctors often refer to this as healthcare-associated MRSA (or HA-MRSA).

Hospital patients are more at risk because:

  • they often have an entry point for the bacteria to get into their body, such as a surgical wound
  • many patients are older and weaker, which makes them more vulnerable to infection
  • they are surrounded by a large number of people, which means bacteria can easily spread through direct contact with other patients or staff or contaminated surfaces

More recently, MRSA has been known to develop outside hospitals and nursing homes. This is known as community-associated MRSA (or CA-MRSA). It is more common in crowded environments where there is frequent skin-to-skin contact and hygiene is poor, such as sports teams, gyms, homeless shelters or army bases.

Read more about the possible causes of MRSA

Preventing MRSA

In recent years, rates of MRSA have fallen because of increased awareness of the infection by both medical staff and the public. However, MRSA still places a considerable strain on healthcare services.

To reduce your risk of an MRSA infection:

  • wash your hands before and after visiting someone in a care home (many hospitals provide antibacterial gel in wards)
  • if you are going into hospital for an operation, ask to be screened for MRSA (see below)
  • don't be afraid to speak to your nurse or doctor if you have any concerns about hygiene in your hospital
  • put all disposable items, such as dressings, into the appropriate bins promptly

Read more about preventing MRSA.

Screening for MRSA

Most NHS patients who are admitted to hospital for a planned procedure are screened for MRSA. This helps reduce the chance of patients developing an MRSA infection or passing an infection on to other patients.

An MRSA infection is most commonly diagnosed using a blood, urine, tissue or sputum (spit) culture.

This involves taking a sample of one or more of these substances and placing them in a dish of nutrients. This should encourage any staph bacteria that are present to reproduce and grow.

If the bacteria develop, different antibiotics can be directed at them to see if the bacteria have developed resistance to the antibiotics.

Read more about NHS screening for MRSA.

Treating MRSA

Minor skin infections may not require any treatment other than draining away any pus from the site of the infection.

Otherwise, infections can be treated with antibiotics that MRSA has not yet developed resistance to. The exact antibiotic used will depend on the specific strain of MRSA involved.

Depending on the severity of your symptoms, antibiotic tablets or injections will be used and you may need to have a much longer course of treatment compared to a normal staph infection.

Read more about treating MRSA.

Common questions about MRSA

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Methicillin-resistant staphylococcus aureus

Symptoms of an MRSA infection depend on what part of the body is infected. Many people carry MRSA bacteria inside their nose but will never experience any symptoms.

The symptoms of an MRSA infection will depend on what part of the body is infected. Many people carry the MRSA bacteria inside their nose but will never have any symptoms.

Skin and soft tissue MRSA infections

Boils and abscesses

An MRSA skin infection usually first develops as a painful bump or a mark in the skin that looks like an insect bite. The bacteria often enter the skin through a cut, graze or a hair follicle. This develops into a painful, pus-filled swelling (boil).

Some people have additional symptoms, such as a high temperature and a general feeling of being unwell. 

In some cases, MRSA can cause a larger, pus-filled lump to develop underneath the skin. This is known as an abscess.

Cellulitis

MRSA contracted outside hospitals or care homes (called community-associated MRSA or CA-MRSA) is much rarer but often causes more extensive skin infections, including a type of infection called cellulitis.

Cellulitis is a bacterial infection of the deeper layers of skin and the layer of fat and soft tissues underneath the skin. The main symptom is the skin suddenly turning red, painful, hot and swollen.

Invasive MRSA infections

If the MRSA bacteria penetrate deeper inside your body or into your blood, they can cause serious infections.

Signs that you may have an invasive infection include:

  • a high temperature (fever) of 38C (100.4F) or above
  • chills
  • a general sense of feeling unwell 
  • dizziness
  • confusion
  • muscular aches and pains
  • pain, swelling and tenderness in the affected body part 

Invasive MRSA infections can lead to the following conditions:

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Methicillin-resistant staphylococcus aureus

MRSA is caused by strains of bacteria that have developed resistance to a number of widely used antibiotics.

MRSA is caused by strains of bacteria that have developed resistance to a number of widely used antibiotics.

How MRSA spreads

MRSA bacteria are usually spread through skin-to-skin contact with someone who has an MRSA infection or who is colonised by the bacteria. Colonised means bacteria are present on your body but do not cause any symptoms.

The bacteria can also spread through contact with towels, sheets, clothes, dressings or other objects that have been used by a person infected with or colonised by MRSA.

MRSA can survive for long periods on objects or surfaces, such as door handles, sinks, floors and cleaning equipment.

MRSA in hospital

It's more common for someone to develop MRSA while they are in hospital or a care home (known as healthcare-associated MRSA - HA-MRSA). This is because people in hospital:

  • often have a point that allows bacteria to enter their body, such as a surgical wound, burn, catheter (a tube used to drain away urine) or an intravenous tube - if a patient who is colonised with MRSA bacteria touches their wound or catheter tube, they may infect themselves
  • tend to be older and have more complex health problems than the general population - which makes them more vulnerable to infection
  • are surrounded by a large number of people, both patients and staff - this makes it is easier for bacteria to spread from person to person, or from a person to an object and then to another person

Who is at risk?

You may be at an increased risk of developing MRSA in hospital, if you have:

  • a weakened immune system, for example in elderly people, newborn babies and people with a long-term health condition, such as type 2 diabetes
  • an open wound
  • a catheter or an intravenous drip
  • a burn or cut on the skin
  • a severe skin condition, such as a leg ulcer or psoriasis
  • surgery
  • are taking frequent courses of antibiotics

MRSA infections usually develop in people being treated in hospital, particularly patients in intensive care units (ICUs) and on surgical wards.

MRSA in the community

MRSA contracted outside hospitals is known as community-associated MRSA (CA-MRSA). It's much less common than HA-MRSA.

However, in recent years the number of cases has increased and could continue to increase in the future. The following factors increase your risk of getting CA-MRSA:

  • living in a very crowded environment - for example a military base, prison or student hall of residence
  • frequent skin-to-skin contact - outbreaks of CA-MRSA have been reported in people who play contact sports, such as rugby
  • cut or grazed skin - this is more vulnerable to infection, as are people who regularly inject illegal drugs, such as heroin
  • contaminated items and surfaces - places where many people share utensils, tools or where many people are likely to touch the same surfaces
  • lack of cleanliness - outbreaks of MRSA can occur in homeless people or in people on active military duty who have limited access to cleaning facilities
  • previous use of antibiotics
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Methicillin-resistant staphylococcus aureus

If you are diagnosed with an MRSA infection, your recommended treatment plan will depend on several factors, such as the type of infection you have.

If you are diagnosed with an MRSA infection, your recommended treatment plan will depend on several factors.

These include:

  • the type of infection you have
  • the site of the infection
  • the severity of your symptoms
  • the antibiotics that the specific strain of MSRA is sensitive to

Some possible treatment plans are outlined below.

Colonisation

You may be screened for MRSA if you are going into hospital. If you are found to be colonised with MRSA (where bacteria are present on your body but they do not cause any symptoms), removing the bacteria is usually relatively straightforward.

An antibacterial bodywash or powder can be used to remove MRSA from your skin. A cream can be used to remove it from inside your nose and an antibacterial shampoo can be used to remove it from your scalp.

You will usually be asked to repeat the process once a day for five days. You do not have to be admitted to hospital to carry out the process. You can do it at home before you go into hospital.

Read more about screening for MRSA.

Skin and soft tissue infections

Minor skin and soft tissue infections, such as smaller boils or abscesses, may only require a treatment called incision and drainage.

Incision and drainage involves piercing the tip of the boil or abscess with a sterile needle or scalpel. This encourages the pus to drain out, which should help relieve pain and stimulate the recovery process. Before having the procedure, you are likely to be given a local anaesthetic to numb the affected area.

More extensive skin infections, such as cellulitis (an infection of the underlying layers of skin), will usually require a 5- to 10-day course of antibiotic tablets.

It is hard to predict what antibiotic you will be given. The choice depends on the result of testing and, in some cases, what part of the country you live in. Different regions of England often have different patterns of antibiotic resistance.

You're likely to be given a 7- to 14-day course of antibiotic injections if you develop a skin or soft tissue infection in hospital and you're more vulnerable to the effects of the infection. This might be because you have burns or a surgical wound.

Invasive infections and MRSA carriers in hospital

If you are found to carry MRSA, or are infected with MRSA in hospital, it's likely that you will need to be transferred to an isolation room. This reduces the risk of the bacteria spreading to other patients and possibly infecting them.

You may be placed in a room by yourself or in a small ward with other people who have an MRSA infection. You should still be able to have visitors, but it is very important that they clean their hands thoroughly before and after visiting you and before and after touching you.

Treatment for an invasive MRSA infection will involve a course of antibiotic injections. Depending on the type and location of the infection, this could last up to six weeks.

A combination of antibiotics may be used.

Click on the links below for more information about different types of invasive infection:

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Methicillin-resistant staphylococcus aureus

FAQs on screening for MRSA

This page contains answers to some frequently asked questions (FAQs) about MRSA.

Why am I being screened for MRSA?

Many people carry MRSA on their skin or in their nose.

If the NHS hospital find you are carrying MRSA before you go in, it can use a simple treatment to get rid of as much of the bacteria as possible. This means there is a smaller chance of you getting an MRSA infection or passing MRSA on to another patient.

When and where will I be screened for MRSA?

Usually you will be screened before you come into hospital for an operation. This may be in a pre-admission assessment clinic, an outpatient clinic or sometimes at your GP surgery.
 
Typically, a nurse will take swabs as part of other checks, such as blood pressure and blood tests, leading up to your hospital stay.

How will I be screened for MRSA?

A nurse will take a sample of bacteria using a swab. A swab is a cotton bud that is placed on the area of skin to be tested. Swabs may be taken from different places, such as the inside of your nose, your armpit or your groin. Swabbing is painless and only takes a few seconds.

When will I get the results from the swabs?

Your swabs will be sent to a laboratory, which tests them for MRSA. The results usually take three to five days, but may come back on the same day.

What happens after I have been screened?

If you are found to be carrying MRSA on your skin or in your nose, you will be contacted by the hospital or your GP. Don't worry if you are contacted. Many people carry MRSA. Carrying MRSA does not make you ill and you are not a risk to healthy people. Healthy older people, pregnant women and children are not usually affected by MRSA. A doctor or nurse will let you know what to do next.

If you are not carrying MRSA, you are unlikely to be contacted by the hospital or your GP. If you are not contacted, continue with your hospital care as planned.

What happens if I am a carrier of MRSA? 

If you are carrying MRSA on your skin, you may not be able to have your planned operation or procedure straight away. You may need to be treated for MRSA first to protect you and other patients from getting ill.

What treatment is used to get rid of MRSA from my skin?

Your doctor or nurse will discuss treatment with you. It usually involves using an antibacterial wash or powder and a special cream in your nose.

You may be asked to change your clothes, sheets and pillowcases every day, usually for five days.

You do not need to be in hospital while you are using the treatment. Continue until the day of your operation or procedure or until the five days are complete. You do not usually need to be screened again before you come into hospital.

What if my operation is urgent?

If your operation is urgent and you need to go into hospital quickly, you may be admitted to a side room in the hospital and started on MRSA treatment as soon as possible.

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