MRSA Action UK | Symptoms

Symptoms & treatment for MRSA infection

The symptoms of an MRSA infection will depend on what part of the body is infected. MRSA can infect a range of body tissues and organs. Here we discuss different types of infection, its causes, diagnosis, treatment and precautions to stop its spread.

Skin infection

Most Staphylococcus aureus infections are skin infections, including:

boils (pus-filled infections of hair follicles)
abscesses (collections of pus in pockets under the skin)
styes (infection of glands in the eyelid)
carbuncles (large pus-filled lumps under the skin)
cellulitis (infection of the skin and the fat and tissues that lie immediately beneath it), and
impetigo (a highly contagious skin infection that produces pus-filled blisters).

You should keep an eye on minor skin problems like spots, cuts or burns. If you have a wound that becomes infected you should see your doctor.

An MRSA-infected wound will become red, swollen and tender, with yellow pus seeping from it. Skin ulcers, such as pressure ulcers, are often sites of infection.

Bloodstream infection

Bloodstream infections are often a secondary infection relating to infection somewhere else in the body, for example a wound, urinary tract, chest or medical device-related infection, such as a catheter or an intravenous tube. If MRSA bacteria enter into the bloodstream from your skin, they can affect almost any part of the body. They can cause:

septic shock (widespread infection of the blood that leads to a fall in blood pressure and organ failure)
severe joint problems (septic arthritis)
bone marrow infection (osteomyelitis)
internal abscesses anywhere within the body
infection of the brain lining (meningitis)
pneumonia, or
infection of the heart lining (endocarditis)

Causes of MRSA infection

MRSA will not normally infect a healthy person. Healthy people can carry MRSA harmlessly on the surface of their skin and never become unwell. Although it is possible for people outside hospital to become infected, MRSA infections are more common in settings in which healthcare is delivered because people receiving care often have an entry point for the bacteria to get into their body, such as a surgical wound, a catheter or an intravenous tube. For example:

if a patient colonised with MRSA bacteria touches their wound or catheter tube, they may infect themselves
they tend to be older, sicker and weaker than the general population, which makes them more vulnerable to infection
they are surrounded by a large number of other patients and staff who move between patients performing lots of tasks that involve touch, so the bacteria can spread easily via the hands - particularly of staff, making hand hygiene at the right time very important

How it 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. This is why hand hygiene at the right time is a critical action to stop the spread of MRSA from one person to another. Since staff touch many patients in their day-to-day work it is particularly important that they clean their hands at the right time.

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

During bed making, for example, skin scales from an infected or colonised person may inadvertently contaminate nearby surfaces and then contaminate the hands of staff making cleaning of the environment important in addition to cleaning of hands.

MRSA can survive for long periods on objects or surfaces such as door handles, sinks, floors and cleaning equipment. MRSA can then be picked up by the hands of healthcare workers and carried to patients with the opportunity to enter the body through a surgical wound, a catheter or an intravenous tube, which is why it's important that staff clean their hands at the right moments to stop MRSA from spreading.

Diagnosis

MRSA infections are diagnosed by testing blood, urine or a sample of tissue from the infected area for the presence of MRSA bacteria. If MRSA bacteria are found, further tests will be done to see which antibiotics the bacteria do not have resistance to, and so which can be used to treat them.

Many hospitals now test or screen patients who are being admitted to see if they are carrying MRSA. Swabs from the skin and nose, urine and blood samples may be tested for the bacteria. It can take 3-5 days for the results to come back. More information is available on our screening for MRSA page.

If you are colonised with MRSA you may still be admitted, but doctors will give you treatment to reduce or remove the MRSA bacteria.

Treatment

Bacterial infections are treated with antibiotics. However, MRSA bacteria are resistant to meticillin (a type of penicillin antibiotic), and usually to some of the other antibiotics that are normally used to treat S. aureus infections. Therefore MRSA infections are more difficult to treat than other bacterial infections.

Antibiotics can still be used to treat MRSA, but you may need a much higher dose over a much longer period, or treatment with an antibiotic to which the bacteria is not resistant. Antibiotics that are effective against MRSA include vancomycin or teicoplanin, which are normally given by injection or intravenously (through a tube straight into your vein), or linezolid, which can be given into a vein or swallowed.

You will usually require treatment in hospital. You may be moved to a single room or to a room with others who have the bacteria, to stop the MRSA spreading. Some people will need to continue treatment for several weeks at home.

Prevention

Healthcare staff, patients and hospital visitors can take simple hygiene measures, such as regular hand cleaning, to help prevent the spread of MRSA and stop infection. Since staff touch many patients in their day-to-day work it is particularly important that they clean their hands at the right time.

Hospital Staff

Hospital staff should clean their hands at key moments to stop the spread of MRSA from one patient to another and as a simple rule there are a number of important times:

1. Before anyone touches you

2. Before health-care workers perform a clean/aseptic procedure, such as inserting an IV (intravenous catheter)

3. After tasks which might lead to exposure to body fluids, such as emptying your urinary catheter

4. After anyone touches you and after anyone touches things in your care area, such as bedrails or your medical chart

5. Before handling food, drink or your medication

Hands can be washed with soap and water or, if they are not visibly dirty, a fast-acting antiseptic solution like an alcohol rub or gel can be used.

Disposable gloves should be worn when staff touch open wounds; for example when changing dressings, handling needles or inserting an intravenous drip, or when staff have the potential to have contact with blood or body fluids. Hands should be cleaned before putting the gloves on and after gloves are removed.

The hospital environment, such as floors, toilets and beds, should be kept as clean and dry as possible.

Patients with a known or suspected MRSA infection should be isolated.

Patients should only be transferred between wards when this is absolutely necessary.

The aim is to reduce the chance of patients infecting themselves and others.

Patients

Hospital patients can reduce their risk of infection by taking the following sensible precautions:

Making sure they have soap, a flannel and moist hand wipes, and their own razor
Always washing their hands after using the toilet or commode
Always washing their hands or cleaning them with a hand wipe or hand rub immediately before and after eating a meal
Making sure their bed area is regularly cleaned and any unclean toilet or bathroom facilities are drawn to the attention of staff
Patients should advise nursing staff if they are concerned about their wounds, or their intravenous cannulae site (drip site) becomes sore or inflamed

Visitors

MRSA does not usually harm healthy people; for example, it cannot harm pregnant women, children or babies, providing they are fit and healthy. Therefore, if you have an MRSA infection, you will still be able to have visitors as normal - indeed this is very important to reassure and support you.

However, it is essential that all visitors wash their hands thoroughly before and after visiting and when they leave.

Visitors can reduce the chance of spreading MRSA to other people if they do not sit on the bed and if they clean their hands before and after entering the ward. They should use alcohol gel before touching the person they are visiting.

Dispensers of alcohol gel or hand rub are often placed by patients' beds so that they can be rapidly and easily used at the key moments. Sometimes they are available and at the entrance to clinical areas - but it is important to remember the key moments for hand hygiene as described in the previous section.

If you have an MRSA infection and someone who is at increased risk wishes to visit you in hospital, you should ask the hospital staff for advice before they visit.