AVMA
<http://www.avma.org/animal_health/mrsa_faq.asp>
Frequently Asked Questions about Methicillin-resistant Staphylococcus aureus (MRSA)
Q:
What is MRSA?
A: MRSA (usually pronounced "mur-sah") is a type of bacteria. Staphylococcus aureus is a common bacterium on
skin, and it is not usually a problem. However, when the Staphylococcus aureus bacteria are not susceptible to the
antibiotic methicillin (ie, methicillin does not kill the bacteria or stop its growth), it is considered to be MRSA. Bacteria
resistant to methicillin are often resistant to other antibiotics as well.
For many years, MRSA was thought to occur only in humans, until a report of a MRSA infection in a dairy cow was
reported in 1972. Now it has become an increasingly urgent problem in veterinary medicine, with MRSA infections
reported in horses, dogs, cats, pet birds, cattle and pigs.
Q:
How common is MRSA?
A: MRSA is a major pathogen in both nosocomial (infection acquired in a hospital) and community-acquired (the
infection comes from a non-hospital source) infections worldwide. According to the Centers for Disease Control and
Prevention (CDC), it is one of the most common causes of human skin and soft tissue infections in the United States.
In the United States, MRSA is the 10th leading cause of death in humans, and is the most frequently identified
antimicrobial drug-resistant pathogen (a pathogen is a disease-producing organism, such as a virus or bacteria) in
hospitals and other healthcare facilities. In 2007, the Association for Professionals in Infection Control and
Epidemiology, Inc. (APIC) reported more than 1.2 million patients in the US were infected with an MRSA strain.
Q:
Where do you find MRSA?
A: If MRSA is present, it is commonly carried on the skin or in the nasal passages of healthy people and/or pets. If
an infection is present, it can be found almost anywhere—especially where there's a skin wound or sore. A person (or
animal) carrying the bacteria on their body but does not exhibit symptoms of disease is considered to be "colonized".
Those who do exhibit symptoms are considered "infected".
Q:
Are there different types of MRSA?
A: Yes. There are two types of MRSA. Community-acquired MRSA, also called community-associated MRSA, is often
abbreviated CA-MRSA. These infections occur in otherwise healthy people without a recent history of hospitalization
or medical procedures, and are usually associated with skin infection. CA-MRSA in humans is thought to be the major
factor in the rise of MRSA infection in animals.
Nosocomial, or hospital-acquired (hospital-associated) MRSA, is abbreviated HA-MRSA. These infections commonly
occur in people with weakened immune systems in hospitals and healthcare centers.
Q:
How is MRSA transmitted?
A: MRSA is spread by direct physical contact with another person or animal. The bacteria can also be spread when
an animal or human comes into contact with objects that are contaminated. These objects include clothing, towels,
bedding, bandages, and medical or sports equipment.
Originally, it was thought that the transmission of MRSA between animals and humans was only from human to
animal, via contact between the hands of the human to the nostrils of the animal. However, there is increasing
evidence indicating that MRSA can be transmitted in both directions, from human to animal (reverse zoonotic) and
from animal to human (zoonotic). Once exposed to MRSA, animals can become colonized, and may serve as
reservoirs to transmit the infection to other animals, as well as back to their human handlers (reinfection). Until the
MRSA has been cleared from the animal (and the animal is therefore "decolonized"), there is a possibility that re-
transmission from animal to human and further human-to-human transmission can occur.
Q:
What are the risk factors for animals and humans contacting MRSA?
A: Risk factors for CA-MRSA include: crowded living conditions, frequent contact, broken skin, contaminated
surfaces and shared items, and poor hygiene.
Risk factors for HA-MRSA include hospitalization, surgery, dialysis, long-term care, and a history of previous MRSA
infection.
For both people and animals, efforts need to be made to decontaminate their shared surroundings. Poor living
conditions play a major factor in MRSA transmission. These conditions include: crowding, compromised skin,
contaminated items or surfaces, and poor hygiene. This area needs to be addressed by both health care workers
and veterinary providers.
Q:
Are certain people at higher risk for acquiring a CA-MRSA infection?
A: Yes. People at higher risk for MRSA skin infections include:
Hospital patients
Incarcerated individuals
Nursing home residents
Children in day care
Athletes
Military recruits
People with weakened immune systems (i.e., immunocompromised)
While healthy people with healthy skin are at low risk for getting an MRSA skin infection, it has happened.
Q:
Are certain animals at higher risk for acquiring an MRSA skin infection?
A: Yes. As with people, animals with weakened immune systems are more likely to become colonized or infected with
MRSA.
The risk factors for animals vary with different species:
For small animals (dogs, cats, pet birds), risk factors may include:
living with immunocompromised people
living with human health care workers
living with veterinary clinic personnel
involvement with therapeutic visits to hospitals, nursing homes, long-term care facilities
For large animals (horses, cattle, pigs), risk factors may include
nasal/facial contact with human handlers
transportation/sale of animals (spreading the risk of transmission from exposed animals to non-exposed animals)
It is important to remember to always be careful in avoiding contact with animal feces (stools). This is especially wise
when handling pet birds and their cages.
Q:
Can I get MRSA by eating meat or dairy products from an infected/colonized animal?
A: MRSA outbreaks have occurred from food through contamination by infected food handlers, but this is not very
common, and can be prevented by proper pasteurization and food handling. To date, there have been no confirmed
cases of food-borne MRSA infection from animals.
Q:
What are the symptoms of MRSA?
A: Not all humans or animals who encounter MRSA develop symptoms. While research is ongoing, it appears only a
small percentage become ill, while most eliminate the organism or become colonized without developing any
symptoms.
Humans exhibit symptoms ranging from minor skin conditions (pimples, boils and skin infections) to more severe
diseases such as postoperative wound infections. MRSA can also cause pneumonia, meningitis (swelling of the
tissues surrounding the brain and spinal cord), blood infections, and heart problems.
The most common animal infections occur at surgery sites or skin wound sites, but infections can occur that range
from skin infections to pneumonia.
Q:
What should I do if I think I may have an MRSA infection?
A: Contact your healthcare provider as soon as possible and have tests conducted to determine if you have an
MRSA infection.
Cover skin infections with clean bandages
Wear protective clothing
Wash hands with soap and water frequently
Clean your surroundings thoroughly, including any items that may have become contaminated.
If you or your animal is diagnosed with MRSA, provide this information to all healthcare or veterinary care providers,
even after the infection is cleared.
Inform people you know or live with there is a possibility they and their animals may have been exposed to MRSA.
They should check with their healthcare or veterinary care providers.
Q:
What should I do if I think one of my animals may have an MRSA infection?
A: Contact your veterinarian as soon as possible and have tests conducted to determine if your animal does have
an MRSA infection or if they're an MRSA carrier. Then follow the same rules listed above.
Q:
What is the treatment for MRSA?
A: MRSA skin infections in humans should be treated by a healthcare provider.
When animals are colonized with MRSA (usually by testing swabs taken of the nostrils), there are no recognized
methods for decolonizing them. Based on clinical cases observed, many experts believe companion animals are
generally transient carriers of MRSA, meaning they are colonized for about 2-3 weeks, so decolonization is not
necessary. Isolating the animal from the human until the animal is no longer colonized is likely to be effective in
preventing reinfection of the human.
In cases of skin infections - the most common type of infection found in animals - an option may be either applying
antibiotic cream to the skin infection, treat the animal with other antibiotics, or a combination of both. Your
veterinarian will determine the appropriate treatment for your animal based on their exam, the animal's history, and
the laboratory results.
Q:
If I and/or my animal have had MRSA, and have been successfully treated, are we safe from getting it again?
A: No. It is possible to have a MRSA skin infection come back after it appears to be cured. To prevent this from
happening, follow your healthcare provider's and veterinarian's directions while you or your animal has the infection.
Follow these prevention steps to prevent further outbreaks:
Wash your hands thoroughly and frequently with soap and water
Keep cuts and scrapes clean and covered
Be careful when tending wounds of other people or animals, especially when changing their bandages.
Thoroughly clean any possible objects you or your animal may have come into contact
Good hygiene is the essential key to preventing further outbreaks of MRSA.
The American Veterinary Medical Association is coordinating with the American Medical Association (AMA), other
veterinary associations, the US Centers for Disease Control and Prevention (CDC), US Department of Agriculture
(USDA), and other national and international partners to obtain accurate information, and will provide additional
information to health professionals and the public as it becomes available.
Links to more information about MRSA
Scientific Backgrounder
CDC MRSA
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_clinicians.html#1 http://www.cdc.gov/ncidod/dhqp/ar_MRSA.html http:
//www.cdc.gov/ncidod/dhqp/ar_mrsa_in_schools.html http://www.cdc.gov/ncidod/dhqp/ar_MRSA_ca_public.html
USDA MRSA
http://www.aphis.usda.gov/vs/ceah/cei/taf/emergingdiseasenotice_files/mrsa_122007.pdf (PDF, 131 Kb)
Science and Development Network MRSA
http://www.scidev.net/en/health/antibiotic-resistance/features/antibiotic-resistance-frequently-asked-questions.html