Nationwide, there has been an increase in the number of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections among persons of all ages who previously were considered to be at low risk for this infection.
CA-MRSA infections are predominantly skin and soft tissue infections (SSTIs). The infection is often described as a “spider bite” or appears as reddened areas on the skin.
Proper infection-control practices and appropriate antimicrobial agent management can help limit the emergence and spread of MRSA in the community and health care settings.
Staphylococcus aureus (S. aureus) is a gram-positive bacterium that can be found on the skin and in the nose of approximately 20% – 30% of healthy individuals. It is one of the most common causes for skin and soft tissue infections (SSTIs) in the United States and may also cause invasive disease, including surgical wound infections, bacteremia, pneumonia, necrotizing fasciitis, and toxic shock syndrome. During the past 50 years, treatment of S. aureus infections has become more difficult due to increasing antibiotic resistance.
Methicillin-resistant Staphylococcus aureus bacteria (MRSA) were first recognized in the 1960’s and soon became identified as a source of infection in hospitals and other health care facilities. Beginning in the 1990’s, there has been an increase in MRSA infections among persons who have onset in the community and who do not have health care facility exposure. This pathogen is referred to as community-associated methicillin-resistant Staphylococcus aureus or CA-MRSA. Since there is no nationwide surveillance system for CA-MRSA, the incidence and prevalence in the United States and in New York State are unknown at this time.
Until recently, reports of CA-MRSA outbreaks had been uncommon. However, nationwide and in New York State, outbreaks are being reported with increasing frequency in a variety of community settings, especially where there is close physical contact or close living conditions. Outbreaks have been reported among members of sports teams, children in day care centers, prisoners, injection drug users, men who have sex with men, military personnel living in a dormitory setting, and Native Americans. Frequent skin-to-skin contact between individuals, compromised skin surfaces, sharing of personal items that may become contaminated with wound drainage, contact with contaminated surfaces, and poor personal cleanliness and hygiene are factors that may increase the risk of CA-MRSA transmission.
The New York State Department of Health is advising health care providers about the growing number of CA-MRSA infections in persons of all ages who previously were considered to be at low risk for infection.
The information provided in this advisory is principally based on the report “Strategies for Clinical Management of MRSA in the Community: Summary of an Experts’ Meeting Convened by the Centers for Disease Control and Prevention. March 2006.”
The spectrum of disease caused by CA-MRSA appears to be similar to that of methicillin-susceptible S. aureus (MSSA). The severity of SSTIs varies from mild superficial infections to deeper soft-tissue abscesses requiring hospitalization for surgical incision and drainage and delivery of intravenous antibiotics. The most common clinical manifestations are:
Although CA-MRSA usually presents as a SSTI, it can also cause invasive disease. Invasive manifestations occur as complications of preceding SSTIs or viral respiratory tract infections (particularly influenza), as well as invasive disease without recognized preceding infections or risk factors.
Prevention and Control
Intact healthy skin is a natural barrier for infection. Therefore, preexisting cuts, abrasions or other irritated areas can contribute to skin infections, as bacteria find an entry point in the broken skin.
Use contact precautions for patients in acute care inpatient settings known or suspected to be infected or colonized with MRSA. This includes:
Household and Community Setting:
Patient education is a critical component of SSTI case management. To prevent spread of MRSA to others in the community, patients with MRSA, family members, household members, and close contacts should be counseled about the following control recommendations.
Patients with suspected or confirmed MRSA infections should:
Patients and their family, household members, and close contacts should:
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Information on MRSA and CA-MRSA can also be found on the CDC website at:
and at the NYSDOH website at: