Treatment of these multiple drug resistant organisms, pose unique challenges to clinicians, clinical microbiologists, infection control professionals and antibacterial-
discovery scienties. It is generally recognized that patients infected with MRSA and ESBL- producing organisms are at risk for poor outcome if they are treated with anti bacterials to
which the organisms exhibits high level resistance. The mortality rate in these susceptibility mismatched patients has ranged from 42-100. Chong Yet al. 2011
1. Methicillin- Resistant Staphylococcus Aureus MRSA
MRSA was first described in 1961, almost immediately after the agent was introduced into clinical practice. MRSA are a type of staphylococcus bacteria that are resistant to many
antibiotics. MRSA bacteria are more likely to develop when antibiotics are used too often or are not used correctly. Staphylococcus bacteria only become a problem when they
cause infection. For some people especially those who are weak or ill, these infections can become serious.
MRSA in an opportunistic bacterium which may colonize and grow readily on the skin and mucous membranes of a person without harm to that person. It competes with other
microorganisms found on the skin surface and is commonly found in the nose, groin, perineum or any other warm, moist sites. The human skin is constantly shedding skin
scales-MRSA is shed with the skin as it falls from the human body. The greater the number of MRSA colonies on a person, the greater the potential for contamination of the
environment and the transmission of MRSA to others.
Infected and colonized patients are the reservoir of MRSA both in hospital and the community with transmission generally being via contact with health workers. Effective,
rapid laboratory diagnosis and susceptibility testing is critical in treating, managing any preventing MRSA infections.
1.1. MRSA Infections in Hospital
MRSA that is acquired in a hospital or healthcare setting is called healthcare-associated methicillin-resistant Staphylococcus aureus HA-MRSA. In most cases, a person who is
already sick or who has a weakened immune system becomes infected with HA-MRSA. These infections can occur in wounds or skin, burns, and IV or other sites where tubes
enter the body, as well as in the eyes, bones, heart or blood. Some patients harbor MRSA on their skin or nose without harm „colonised‟. However these patient may develop
infections if the MRSA spread to other parts of the body e.g. if MRSA spread from colonized nose to a wound. When this happens the resulting infection is described as
„endogenous‟. Some patients are at increased risk of developing infection. They include those with breaks in their skin due to wounds or indwelling catheters which allow MRSA to
enter the body, and those with certain types of deficiency in their immune system. This includes patients who: i. Are in hospital and long-term care fascilities for a long time, ii. Are
on hemodialysis, iii. Receive cancer treatment or medicines that weaken their immune system, iv. Inject illegal drugs, v. Had surgery in the past year.
The prevention of horizontal transmission of MRSA has become increasingly important as the prevalence of this pathogen increases. Oral carriage of MRSA may serve as a
reservoir for re-colonization of other body sites or for cross-infection to other patients or health care workers. Therefore, it is important that consideration be given to the oral cavity
if eradication of colonization by MRSA is clinically appropriate. Eradication of throat carriage of MRSA has been achieve with use of topical chlorhexidine 0.2 in addition to
normal control measures of patient isolation, nasal mupirocin and chlorhexidine body washes.
1.2. MRSA infection in the Community
