Many people may not be familiar with Methicillin-resistant Staphylococcus aureus (MRSA), pronounced mersa, but the word staph probably triggers some recognition. MRSA is a very contagious bacteria that can be quite deadly. In 2005, according to the Centers for Disease Control and Prevention (CDC), 94,360 infections were caused by MRSA, and 20 per cent of these were fatal. Hospitals, nursing homes and clinics are particularly susceptible to spreading the infection.
MRSA finds its way into the human body through ports like feeding tubes and catheters. It also gains access through wounds and surgery. Feeding tubes are especially vulnerable sites of entry because they reach from outside of the body all the way into the stomach, past a lot of natural defences. There are two types, a nasogastric (NG) tube that goes into the nasal passage, down the oesophagus and into the stomach; and a Percutaneous endoscopic gastrostomy, or Peg tube. The Peg tube is inserted directly into the stomach while the patient is under anaesthesia.
Feeding tubes are used when patients cannot eat normally; for instance, the gastric system may need a rest after surgery or a patient cannot swallow due to paralysis. Premature babies need extra nutrition but some times they lack the reflex to suck and cannot feed from a bottle.
There are two types of MRSA, hospital and communicable. The hospital variety gets its name from the facility where it occurs, a setting where the bacteria can be spread from one patient to another through the nursing staff. Since staph can live on the skin and in the nostrils, it can easily be transmitted from a person's hand onto a feeding tube and then into the body. The communicable variety occurs outside of the hospital setting, and can also spread through skin contact, for instance that found in sports.
Washing the hands with an antibacterial soap before touching the feeding tube can cut down on the incidence and spread of bacteria. Keep the wound site around the tube clean, and the nasal area cleaned of mucus. Maintain clean bedding; wash clothes and towels often. This holds true for caregivers in a home situation. If MRSA is present, hand washing, gloving, gowning, masks and strict disposal of wastes are vital strategies.
MRSA that travels through the bloodstream is referred to as a blood infection, or septicaemia. It can enter the lungs, causing pneumonia. If it reaches the heart and attaches to the valves patients suffer endocarditis, and heart failure. It can also attack the bones and joints and, in severe enough cases, amputation is called for.
For a patient with a feeding tube, the bacteria can travel very quickly, invading the stomach and the entire digestive system. Symptoms may not occur right away. An abscess around the tube entry site might appear, but the first sign can be a high fever.
Antibiotics are used to combat the bacteria. An infectious disease specialist may take charge of the treatment and try to deliver the proper mix that will be effective. Treatment can take several weeks if the infection has reached a vital organ. In some cases, surgery may be necessary to remove abscesses, particularly on heart valves.
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