MRSA and the environment

Question

Dear expert team,

in the family of a friend, MRSA was detected: 2 CF children, father also MRSA-positiv, mother free of MRSA.

What does this mean for the contact to the environment, e.g., contact with families with healthy babies, ill friends (no CF) or with friends suffering from CF, and contacts during work?

Thanks for the info.

Answer

Hello,

MRSA (Methicilline-resistant Staphylococcus aureus, a germ that does not react anymore to the antibiotics usually administered against it in the past) is mainly a problem in the hospital and in health care facilities (hospital: www.mrsa-net.org/ENG/institution/hospital.html, patient transport: www.mrsa-net.org/ENG/institution/patient-transport.html, laboratory: www.mrsa-net.org/ENG/institution/laboratory.html, public health service: www.mrsa-net.org/ENG/institution/public-health.html, medical practice: www.mrsa-net.org/ENG/institution/gps-outpatient.html). In the domestic environment, the problem is much smaller; therefore, the safety measures against infection outside the aforementioned areas are not regulated by law.

MRSA-net, a consortium whose goal it is to get the problem under control, says the following about this: “There are many other areas where questions regarding MRSA are arising, such as the handling of MRSA in kindergartens, . . . Frequently, no evidence exists for the correct handling of MRSA within these sectors.”

It is important to state that, for people with an intact immune system, the problem is not as big as for special-risk patients. Therefore, of course, one does not only have to stay with this germ at home.

We asked Prof. Döring, one of our CF infection specialists, and he writes:

"Generally, MRSA strains are more toxic than the antibiotics-sensitive MSSA strains. Less in Europe but specifically in North America, there are very toxic MRSA strains. Therefore, a contact with any of your mentioned persons should be avoided and the colonized persons should try to eradicate the pathogen with the help of a doctor." [end of Prof. Döring's answer]

Thus, avoid unnecessary risks, and particularly the last sentence is important: try to get rid of MRSA again.

As for the various aspects, the following is an attempt to classify them:

Families with (healthy) babies: avoid
Families with sick friends (not CF, urol. problems): avoid
Families with friends who are CF patients: avoid
At work: if there is no special risk, no restrictions

Kind regards,

Prof. Dr. TOF Wagner.

26.02.2009

Addendum: Prof. Tümmler from the medical school Hannover (MHH), who also was involved with this question, gives the following comments:

At the CF outpatient clinic of the MHH we have strict hygienic instructions for dealing with MRSA-positive CF patients. These patients do not have any contact to the regular CF outpatient clinic. The CF specialist meets his patients at the emergency department with respect to the instruction of the Robert-Koch institute (face mask, gown).
According to these measures, the risk of passing on the MRSA to other CF patients should be minimized as far as possible. Therefore I would aggravate the recommendation: no contact with families with friends suffering from CF.

Even if it was not asked specifically, I would consider it to be helpful, if it is recommended to the family, to sanify the affected family members. Guiding principle could be the rigorous strategy of hospitals in the Netherlands, if an MRSA positive patient from Germany wants to be treated in a dutch hospital. (Background: pig holdings in Germany tend to be more and more MRSA positive. Passing on to the agricultural staff is frequent. In case a farmer from the region near the frontier wants to be treated in a neighbouring hospital, he is tested for MRSA first. Only MRSA negative patients are allowed to be treated on a normal ward. All MRSA positive patients need to be sanified first).

Thanks to those rigorous strategy, MRSA incidence and prevalence in the Netherlands is very low, whereas the MRSA quote in the neighbouring countries is growing alarmingly.

Course of action for sanitation of MRSA: local sanitation of the nose with Mupirocin over 7 days, during the sanitation the hands have to be disinfected several times a day. For washing, single use facecloths have to be used. Towels and bedclothes are changed daily.

This rigorous strategy is not generally known in Germany even among physicians. The success rate of the sanitation is high. In case of CF patients, the local anti-staphylococcal therapy should be combined with the oral high dose anti-staphylococcal therapy. The logistic effort is high, but the success rate with MRSA-colonized patients is very high. Controlled studies about the sanitation of MRSA in CF are however not known to me.