The objective of this paper is to trace the epidemiology and pathogenesis of MRSA, analyse the developments in the filed relating to the' infection management' and highlight significant breakthroughs evidence based research has produced and explore the development and effectiveness of Chinese based traditional medicine(s). The Paper would rely on secondary sources of data by drawing up materials from peer reviewed Journals and studies. The Paper is structured as follows;
Staphylococcus is derived from the Greek word staphylococci meaning a bunch of grapes and this bacteria is prefixed with this word because of the fact that they are formed in a cluster. It is gram positive an opportunistic pathogen and intravenous drug user, newborns , elderly and in patients who are in requirement of catheters and other artificial appliances are vulnerable to it. The bacterium produces a glycocalyx 'slime' that acts as a glue adhering it to plastic and cells and this is responsible for causing resistance to phagocytes and some antibiotics. While the infection can occur at any stage, like through the umbilical chord during the child birth,,scepticemia in road accidents, pneumonia, in heart compromised patients, it wrecks maximum damage in a hospital environment because of its Nocosomical characteristics, for it thrives happily hovering round in all nooks and corners of the hospitals.
The reasons attributed to the immunity developed by the bacteria to antibiotic medicine which is in prevalence for the last fifty years relates to its over use and irregular intake. Bacteria being living organisms are capable of adapting themselves to changes quickly and instead of getting killed when an antibiotic is administered, some of them under go a mutation which gives them the strength to such adaptation and resistance. When the intake is irregular in the sense the patient does not take the prescribed medicine for the entire course results in the proliferation of resistant bacteria. The resistant strains develop when inappropriately an antibiotic medicine is prescribed or taken when an infection does not really exist and to treat a virus
A hospital environment is the most vulnerable spot for the activation of the bacteria and the spread of the infection especially arising out of surgical treatment or procedures which causes the germination and spread and also the possibility of elder patients becoming more prone to such infections because of weakened immune systems. Because of their capability to get transferred directly from the hands of the person who come in touch with another person and the necessity of the hospital staff to attend to numerous patients and given the fact that hygienic conditions might not be there or might have been followed partially they turn out to be carriers of cross infection from one patient to another. These bacteria are also capable of surviving and living indirectly in the surfaces of door handles, bed rails and linen and when these items or places are not disinfected they act as ideal sources for the spreading of the infections. Thus, its management is of critical importance in such an environment and evidence based research findings would be most appropriate for the discussion.
III Epidemiology and Pathogenesis of MRSA
:In a study conducted involving 235 patients and 60 hospital staff from the Centre for Haemodialysis, Clinical Center University of Sarajevo, it as found that MRSA was playing a key role in the epidemiology and pathogenesis of infection. The patients undergoing haemodialysis represent one of the high-risk groups for infection caused by these organisms on account of their compromised immune system and the requirement for repeated access to their blood systems multiple times in a week. The hospital staff were found to be active vectors of the cross infection. The specific aim of the study was to assess the carriage rtes of nasal and throat MRSA in patients and hospital staff and the efficacy of mupirocin in the eradication of nasal carriage (Dedeic-Ljubovic, A et al (2006).
From the chosen target group, 474 nose and throat cultures of patients and 120 cultures of hospital staff were performed. Methicillin resistance of S aureus were assessed with disk-diffusion methods according to the standards prescribed by National Committee for Clinical Laboratory Standards (NCCLS) and rapid latex agglutination test through detection of PBP2 (pencillin-bidning protein 2) with the use of product of mecA gene S aureus ATCC 25923 strain for control.
The results indicated a nasal carriage rate of MRSA of 15.3% and 11.6% among the patients and hospital staff respectively leading to the conclusion it is a serious problem. The study had further concluded that topical mupirocin treatment is greatly effective in the eradication of nasal carriage.
A case study relating to post-operative complication arising out of the infection is summarised below (Ashok, R et al, 2004)
A 51 year old obese woman reported with an infection after one year of an abdominal surgery with complaints of pain in the abdomen and repeated vomiting for three consecutive days and accompanying temperature for ten days. One year prior to the complaint, she had undergone a surgery for Para umbilical hernia with a mesh implementation. Clinical results suggested that she had an infection at the site of the operation with all the parameters being consistent in showing an on going sepsis. The CT scan showed fluid collection at the site of previous mesh repair in the abdominal wall. The fluid was drained through an incision procedure. The abscess was drained and the infected mesh was removed, the abscess pus and the infected mesh were sent for microbiology tests. The culture results had indicate pure growth of S. aureus. The isolate was sensitive to Erythromycin, Clindamycin, Vancomycin, Teiroplanin and Minocycline. She was prescribed Cyndamicin orally once in eight hours along with external ointments for the nasal area and antiseptic applications through out the body while avoiding contract with the eyes. After being treated as an in patient for a period of 15 days, she was discharged as the wound had cleared and no further complaints were reported. But, after a period of five months, the patient again returned with fever and complaining diarrhoea. An examination of her revealed that the operated site was again infected with MRSA with a difference that this time the severity of the infection was less. Though the anti-bio-gram of this isolate was similar to the year one, in order to rule out the possibility of endogenous source for the contraction of infection, swab were colleted from the anterior nares6, throat, axilla and going of the patient and MRSA was isolated from all the sites taken up analysis. The hospital staff attending to this patient were also screened for MRSA to rule out the possibility of their transmitting the infection. The anti-bio-grams of all these isolate were similar to the earlier ones, but they tested negative for MRSA. This time she was put under I.V. medication where Vancomycin 500 mg was administered once in 6 hours for a period of 15 days and in addition to that application of 2% mupirocin nasal drops and other skin cleansing antiseptics were carried out. Three sets of screening swabs at weekly intervals were collected and after elapse of the 15th day once it was considered that she was clear of the MRSA, she was discharged. Since then, the patient has reported progress and has been under regular follow up. It is worthy of noting that in addition to the medication, mupirocin was found to be effective which was reported in the previous case also.
