MRSA infections are staphylococcal infections that are resistant to beta-lactam antibiotics including: penicillin, ampicillin, amoxicillin, amoxicillin/clavulanate, methicillin, oxacillin, dicloxacillin, nafcillin, cephalosporins, carbapenems (e.g., imipenem), and the monobactams (e.g., aztreonam).
Infection with MRSA has long been associated with exposure to a health care environment, particularly the inpatient hospital setting. Recent reports, however, indicate that new MRSA strains have evolved that are affecting previously healthy persons throughout the world without direct or indirect contact with health care facilities. These community-onset MRSA infections have particularly affected athletes in close-contact sports, military recruits, men who have sex with men, and inmate populations. Inmates are now at risk of acquiring MRSA infections not only during hospitalizations, but also de novo within the jail or prison setting, despite the absence of traditional risk factors for MRSA infection, such as a history of recent hospitalization, prior antibiotic usage, injection drug use, or long-term inpatient care.
Within the federal prison system, community-onset MRSA infections have been associated with illicit, unsanitary tattoo practices and poor inmate hygiene. MRSA transmission in other correctional systems has been linked to inmates sharing towels, linens, or other personal items potentially contaminated by wound drainage, as well as inmates lancing their own boils or other inmates’ boils with fingernails or tweezers.
MRSA infections often present as mild skin or soft tissue infections, such as furuncles, that occur spontaneously without an obvious source. Inmates with MRSA skin infections commonly complain of “an infected pimple,” “an insect bite,” “a spider bite,” or “a sore”. Many MRSA infections cause minor inflammation without pain and infected inmates may not seek medical attention. Persons with complicating medical conditions such as diabetes, HIV infection, chronic skin conditions, indwelling catheters, post-surgical wounds, and decubiti are at increased risk of MRSA infections; however, even otherwise healthy individuals can develop very serious MRSA infections, such as cellulitis, deep-seated abscesses, necrotizing fasciitis, septic arthritis, necrotizing pneumonia, and sepsis.
Management of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections