Community-associated methicillin-resistant Staphylococcus aureus in Indigenous communities in Canada

Question 1

What is community associated MRSA (CA-MRSA)?

Answer 1

MRSA infection with onset in the community in a person without the risk factors for health care associated MRSA

Question 2

What is the difference between CA-MRSA and HCA-MRSA?

Answer 2

CA MRSA are:

• more susceptible to antimicrobials (excld. beta-lactam)
• associated primarily w/ skin and soft tissue associated infections
• exhibit specific virulence factors that produce cytotoxins capable of inducing tissue necrosis

Question 3

What MRSA types are associated with community infections in Canada?

Answer 3

CMRSA-10

CMRSA-7

Question 4

What percentage of cases of CA-MRSA were in First Nations patients?

Answer 4

• 62% in the Prairie Province (usu. CMRSA10)

- 83% in NWT (usu. CMRSA10)

Question 5

What are risk factors for CA-MRSA outbreaks?

Answer 5

1. Overcrowding
2. Frequent skin-to-skin contact between people
3. Participation in activities that result in abraded or compromised skin surfaces
4. Sharing of potentially contaminated personal items
5. Challenges in maintaining personal cleanliness and hygiene
6. Limited access to health care
7. Lower SES
8. Exposure to antibiotics

Question 6

What should pediatricians do to build awareness of CA-MRSA?

Answer 6

Ensure that health centre staff known that the emergence of CA-MRSA is a cause of infection in affected communities

Question 7

How should pediatricians monitor resistance?

Answer 7

Collect specimens for culture from purulent drainage of abscesses to monitor resistance patterns and guide empirical management

Question 8

What are some measures we should advocate for in Indigenous communities to reduce CA-MRSA?

Answer 8

1. In-home potable water services

2. Improved housing conditions

Question 9

What prevention strategies should be implemented for CA-MRSA?

Answer 9

1. Use evidence-based guidelines to reduce unnecessary antibiotic use
2. Provide educational materials to families about appropriate antibiotic use
3. Practice and promote hand hygiene
4. Encourage seasonal influenza vaccination for all children to reduce severe MRSA pneumonia

Question 10

What infection control practices should be implemented in health centres and clinics for CA-MRSA?

Answer 10

1. Model and reinforce proper hand hygiene
2. Make alcohol based handwashing supplies easily available wherever sinks and running water are less accessible
3. implement routine infection control practices in health centres and appropriate preventive measures following the assessment of a client with an MRSA infection

Question 11

How do you treat infected scratches, furuncles, and impetigo due to MRSA?

Answer 11

1. Wet warm compresses
2. Washing with warm water and soap
3. Consider topical antibiotics depending on local sensitivity patterns
4. Consider oral antibiotics for more severe infections

Question 12

How do you treat abscesses due to MRSA?

Answer 12

1. incision and drainage

Question 13

What are some general management strategies for MRSA?

Answer 13

1. engage community health staff, clients, and communities in preventive approaches
2. keep wounds covered with clean, dry bandages and exclude from contact sports or child care until wound drainage stops or wounds are healed if unable to cover
3. dispose of used dressings in a plastic-lined garbage container with a sealed lid immediately after they are removed
4. practice proper hand hygiene using soap and water or an alcohol-based hand gel before and after changing dressings
5. Bathe regularly and wash clothes and bedding often
6. avoid sharing personal items, esp. towels, bedding, clothing and bar soap
7. seek medical attention if fever or other signs of illness develop, or if a local lesion does not improve within 48h of starting treatment
8. regular cleaning of contact surfaces in the home with a standard household cleaner or detergent
9. consult public health about a recurrent infection (3 or more infections in the same individual within 6m period) or if an outbreak in a closed population, such as day care or athletic team, is suspected
10. avoid determining carriage rates among asymptomatic household contacts
11. reducing microbial carriage for routine management of CA-MRSA infections, in either endemic infection conditions or during an outbreak

Question 14

What are community level interventions for CA-MRSA?

Answer 14

1. provide education and raise awareness about:
   - a/ self care for cuts, scrapes and insect bites
   - b/ hand hygiene, personal hygiene, and regular household cleaning
   - c/ frequent laundering of clothing and bedding
2. improve access to inexpensive laundry services in remote communities