Methicillin-resistant Staphylococcus aureus:
An Overview for Manual Therapists
SOURCE: Journal of Chiropractic Medicine 2012 (Mar); 11 (1): 64–76
Bart N. Green, MSEd, DC, Claire D. Johnson, MSEd, DC,
Jonathon Todd Egan, DC, MPH, Michael Rosenthal, PT, DSc, ATC, CDR,
Erin A. Griffith, DO, Marion Willard Evans, DC, PhD
Chiropractor, Chiropractic Division,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA
OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is associated with difficult-to-treat infections and high levels of morbidity. Manual practitioners work in environments where MRSA is a common acquired infection. The purpose of this review is to provide a practical overview of MRSA as it applies to the manual therapy professions (eg, physical and occupational therapy, athletic training, chiropractic, osteopathy, massage, sports medicine) and to discuss how to identify and prevent MRSA infections in manual therapy work environments.
METHODS: PubMed and CINAHL were searched from the beginning of their respective indexing years through June 2011 using the search terms MRSA, methicillin-resistant Staphylococcus aureus, and Staphylococcus aureus. Texts and authoritative Web sites were also reviewed. Pertinent articles from the authors’ libraries were included if they were not already identified in the literature search. Articles were included if they were applicable to ambulatory health care environments in which manual therapists work or if the content of the article related to the clinical management of MRSA.
RESULTS: Following information extraction, 95 citations were included in this review, to include 76 peer-reviewed journal articles, 16 government Web sites, and 3 textbooks. Information was organized into 10 clinically relevant categories for presentation. Information was organized into the following clinically relevant categories: microbiology, development of MRSA, risk factors for infection, clinical presentation, diagnostic tests, screening tests, reporting, treatment, prevention for patients and athletes, and prevention for health care workers.
CONCLUSION: Methicillin-resistant S aureus is a health risk in the community and to patients and athletes treated by manual therapists. Manual practitioners can play an essential role in recognizing MRSA infections and helping to control its transmission in the health care environment and the community. Essential methods for protecting patients and health care workers include being aware of presenting signs, patient education, and using appropriate hand and clinic hygiene.
From the FULL TEXT Article:
Methicillin-resistant Staphylococcus aureus (MRSA) is a substantial public health problem worldwide, causing significant morbidity and mortality  and elevated health care costs.  There were an estimated 94,360 invasive MRSA infections in the United States in 2005, causing more than 18,000 deaths per year.  Methicillin-resistant S aureus prevalence has increased over the last 10 years; MRSA-related hospital discharges have doubled over 10 years, with hospital discharges for MRSA skin and soft tissue infection tripling since 2004.  Infections caused by MRSA are associated with longer hospital stays [4, 5] and an increased financial burden on society, costing an estimated US $14.5 billion for all inpatient days in 2003.  An example of the increased morbidity and mortality associated with MRSA can be seen when comparing the yearly infection rates and mortality rates in the United States for MRSA, AIDS, viral hepatitis, and tuberculosis. Methicillin-resistant S aureus is estimated to cause more infections than the other diseases combined (Fig 1A) and more deaths per year than AIDS (Fig 1B).
A, Infections per year in the United States. B, Deaths per year in the United States. *Because MRSA is currently not a nationally reportable disease, MRSA estimates of yearly infections and deaths are based on the study by Klevens et al ; and data for AIDS, viral hepatitis, and tuberculosis are from the CDC6 and Boucher and Corey.  (The graphs created by the authors are in the public domain and thus free of any copyright restrictions.)
Methicillin-resistant S aureus is a common problem in health care facilities, sports facilities, clinics, and the community. The MRSA strains associated with hospitals are referred to as hospital-acquired MRSA (HA-MRSA) and are the most common cause of hospital-acquired infections. [2, 5, 8, 9] Methicillin-resistant S aureus is the leading cause of skin and soft tissue infection in patients reporting to emergency departments for treatment,  with a rising rate in primary care clinics  and intensive care units.  Invasive MRSA-related conditions most commonly reported include septic shock (56%), pneumonia (32%), endocarditis (19%), bacteremia (10%), and cellulitis (6%).  Strains associated with the community are referred to as community-acquired MRSA (CA-MRSA) and are also present in people who serve as asymptomatic carriers. 
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