Ms. Terrie is a clinical pharmacy writer based in Haymarket, Va

Reported outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infections, especially in schools, highlight the need for greater public awareness of how these types of infections are transmitted, treated, and prevented.

Transmission of MRSA is typically via direct skinto- skin contact or contact with contaminated surfaces or items.¹ Many of the community-acquired staph infections have occurred among athletes, who share equipment or personal items, and among children in daycare centers.² Due to these outbreaks, some deaths have occurred and caused significant public concern. Not all staph infections are methicillin-resistant, however, and mortality rates associated with community-acquired MRSA (CA-MRSA) infections are low.³

Awareness Key to Prevention

Increasing public awareness of staph infections is critical in order to decrease the potential for additional cases, as well as reduce the anxiety of individuals not knowledgeable about these infections. MRSA can range from mild skin infections to more severe systemic infections, and health care professionals play an essential role in patient health and safety. These professionals can be instrumental in educating patients about staph infections by advocating proper infection control measures, such as frequent hand washing. Many individuals underestimate the value of hand washing in decreasing and preventing the transmission of infections.

Results from a study published in the October 17, 2007, issue of the Journal of the American Medical Association indicate that MRSA infections are considered to be more prevalent than once perceived. The Centers for Disease Control and Prevention (CDC) estimates that, in 2005, approximately 94,000 individuals in the United States developed invasive MRSA infections. Furthermore, an estimated 19,000 deaths that year were the result of MRSA infections, a mortality rate greater than that due to AIDS.^4-7 In addition, the study reported that an estimated 85% of all invasive MRSA cases were associated with health care settings, whereas an estimated 15% of infections were community-related, which means that these infections occurred in individuals without documented health care risk factors.^4,5 CA-MRSA has become the most prevalent cause of skin and soft tissue infections among individuals visiting the emergency room in the United States.^7,8 MRSA also can cause severe invasive infections.^7,8

The Pharmacist's Role

Pharmacists can help decrease the incidence of antibiotic resistance by utilizing their expertise to make clinical recommendations on appropriate antibiotic use, as well as being advocates for practicing infection control procedures, such as good hygiene and frequent hand washing. MRSA, like other superbugs, is the product of decades of excessive and unwarranted antibiotic use.⁸ Leading causes of antibiotic resistance include inappropriate use and overuse of antibiotics, as well as bacterial mutation and possibly the practice of adding antibiotics to agricultural feed.^9,10

As one of the most accessible health care professionals, pharmacists should seize every possible opportunity to counsel patients on the proper use of prescribed antibiotics, explain the warning signs of infection, and provide information on preventive measures for infection control. Patients showing any signs of skin infections should be advised to seek medical attention immediately.

The American Pharmaceutical Association has issued recommendations encouraging patients to confer with their health care providers about appropriate antibiotic use and infection control guidelines.¹¹ One of the greatest tools in the fight against staph infections, particularly MRSA, is increasing public awareness of the importance of infection control and effective means of preventing transmission.

References

1. Questions and Answers about Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools. Centers for Disease Control Web site. www.cdc.gov/Features/MRSAinSchools/#q2. Accessed October 25, 2007.
2. MRSA Infection. National Library of Medicine and National Institutes of Health Medline Plus Web site. www.nlm.nih.gov/medlineplus/ency/article/007261.htm. Accessed October 25, 2007.
3. Johnson L and Saravolatz L. Community-acquired MRSA: current epidemiology and management issues. Medscape Web site. www.medscape.com/viewarticle/498770. Accessed October 23, 2007.
4. CDC estimates 94,000 invasive drug-resistant staph infections occurred in the U.S. in 2005 [press release]. Centers for Disease Control Web site. www.cdc.gov/od/oc/media/pressrel/2007/r071016.htm. Accessed October 22, 2007.
5. Drug-Resistant Staph a Widespread Threat. National Library of Medicine and National Institutes of Health Medline Plus Web site. www.nlm.nih.gov/medlineplus/news/fullstory_56237.html. Accessed October 25, 2007.
6. Drug Resistant Staph Infections Reaching Epidemic Levels in Some Parts of the U.S. National Library of Medicine and National Institutes of Health Medline Plus Web site. www.nlm.nih.gov/medlineplus/news/fullstory_56428.html. Accessed October 24, 2007.
7. Klevens, R, Morrison MA, Nadle J, et al. Invasive methicillin resistant staphylococcus aureus infections in the United States. JAMA. 2007;15:1763-1771.
8. MRSA infection. Mayo Clinic Web site. www.mayoclinic.com/health/mrsa/DS00735/DSECTION=3. Accessed October 25, 2007.
9. MRSA Infections. JAMA. 2007;15:1826.
10. Antimicrobial Drug Resistance. National Institute of Allergy and Infectious Diseases Web site. www3.niaid.nih.gov/topics/AntimicrobialResistance/understanding/causes.htm.
11. APhA Calls for Appropriate Use of Antibiotics - Pharmacists and Other Healthcare Professionals Can Educate the Public. Medical News Today Web site. www.medicalnewstoday.com/articles/85910.php. Accessed October 22, 2007.