Rates of drug-resistant infections are rising around the world, according to the World Health Organization. These infections, called methicillin-resistant Staphylococcus aureus (MRSA) infections, don’t respond to traditional treatments for bacterial infections, such as penicillin.
MRSA in the elderly is a serious problem, especially in institutional settings, where seniors have a higher risk of death from the disease as a result of its resistance to typical antibiotics. While the spread of MRSA infections is most common in hospitals, people with poor functional status are more susceptible to carrying MRSA, and therefore any institutional setting — including nursing homes — must take precautions.
Read on to learn about symptoms, diagnosis, treatment, and precautions for senior MRSA patients.
The combination of frequent use of antibiotics and a weakened immune system make the elderly particularly susceptible to MRSA infections. The elderly are “a population of people who have a history of taking antibiotics in the past, so they have developed some resistance to these drugs,” says Jennifer Morcone, a health communications specialist with the Centers for Disease Control and Prevention (CDC).
Many older people contract the disease in hospitals or long-term care facilities through open wounds or skin-to-skin contact with health care providers’ hands that have been contaminated by other patients with MRSA infections. MRSA in the elderly is also a concern in assisted living communities or at home, although it’s less common in those settings.
MRSA is most common as a skin infection because Staphylococci — or staph — are common bacteria that live on the skin. They cause infection whenever they enter the skin through a cut or sore. A person can also become infected with MRSA when the bacteria move inside of the body through a catheter, a breathing tube, or another entry point.
MRSA infections can be minor, such as a mild scratch or a pimple, but can become problematic if left untreated. A typical staph infection normally causes a red, swollen, and painful area on the skin, according to information provided by the National Library of Medicine. Other symptoms may include:
Symptoms of a more serious staph infection may include:
Patients can get MRSA-causedurinary tract infections (UTIs) if they don’t wash their hands before using the bathroom, but catheters are also one of the most common causes of MRSA bladder infections and UTIs, which are often detected during routine catheter changes. Most patients with MRSA-caused UTIs don’t show symptoms, according to a study published by the National Institutes of Health. The disease is much more serious if related to a surgical wound or UTI, sometimes causing bloodstream infections and pneumonia.
Depending on the extent and severity of the symptoms, a doctor may recommend a:
For MRSA in the elderly, prognosis and treatment depend on the level of severity. Draining the abscess at the doctor’s office is usually the only treatment needed for a local MRSA skin infection.
More serious MRSA infections are treated with a few antibiotics, such as trimethoprim-sulfamethoxazole (Bactrim®), clindamycin, minocycline, doxycycline, and linezolid (Zyvox®).
While seniors with a serious infection may receive intravenous antibiotics for six weeks, others come for a month-long treatment and take their medicine orally.
“People take the pill for 30 days,” says Kristi Lott, a nurse at Queen Anne Healthcare in Seattle, Washington. “They come to get antibiotics for six weeks in the more serious cases,” she says.
“To clear someone, they have to get at least three negative cultures,” says Lott. “Their stay can be shorter, but we still have to rule out infection before we can send them home.”
The most serious MRSA infections are treated in the hospital or a long-term care facility. In these cases, supplemental oxygen and intravenous medication may be part of the treatment. In cases of kidney failure, dialysis may be needed.
MRSA’s deadliness depends on the severity of the infection, but its mortality rates are between 15% and 42%. MRSA infections can be fatal in young people but have higher death rates in elderly patients.
Because of the nature of the disease, preventing and minimizing MRSA in the elderly is an ongoing process that encompasses everything from paying close attention to a skin abrasion to placing an infected patient in seclusion.
The most basic level of prevention simply involves good hygiene, especially when attending a health care center for treatment or visiting someone in a long-term care facility. People should wash their hands frequently and use alcohol-based hand sanitizers. They should avoid sharing personal items such as towels or razors, as MRSA can be transmitted through contaminated items. All wounds should be covered with a clean bandage, and contact with other people’s soiled bandages should be avoided.
Closely monitoring skin wounds of any type is extremely important, whether it’s a minor abrasion or a surgical wound.
“Let’s say you have a scratch and then two days later it’s angry red. Anything that gets darker in color — or if the skin [develops] a hole, or peels away — should be immediately dealt with,” Lott says.
Elderly residents living alone or atassisted living facilities, where they’re not necessarily in constant interaction with a caregiver, tend to overlook an MRSA infection in its early stages.
“They don’t think to tell anyone. It gets worse and worse, and by the time they tell someone, it’s really infected,” Lott says. “A lot of the elderly think it will be OK and don’t want to be a bother.”
But that’s exactly the wrong thing to do because ignoring it gives the infection time to grow, according to Lott. She says this is also a concern for elderly people living with a caregiver, although in this case an obvious skin infection may be noticed by the caregiver.
Once an MRSA infection has been identified, a person must take these steps to prevent it from getting worse or spreading to others:
At-home caregivers for the elderly are less likely to see the infection spread to other members of the household because fewer people are at risk of disease from MRSA outside of health care settings. Nevertheless,these precautions should be followed in the home, according to CDC guidelines:
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As MRSA infection rates continue to rise for elderly residents in hospitals and long-term care facilities such as nursing homes, extra precautions must be taken.
“It’s a major problem,” Morcone says. “Preventing MRSA infections is a priority across health care, including long-term care facilities. Patients who have MRSA can easily spread the infection to others through their own activities or their caregivers’ hands.”
To help prevent the spread of the infection, most institutions isolate affected patients. The extent of this isolation depends on the severity of the infection.
“If the wound is closed, small, and wrapped in dressing and with drainage, the only precaution you have to take is standard isolation,” Lott says.
In standard isolation, caretakers wear gloves, but the infected person doesn’t need to remain quarantined in their room. They can take trips to common areas or visit fellow residents, as long as those residents aren’t carrying a disease or a skin infection. On the other hand, a more serious skin infection — or worse, a blood infection — requires the patient to stay in their room.
Although MRSA in the elderly is a growing problem, health officials stress that these kinds of preventive measures taken by health care providers, caregivers, and MRSA patients make a significant difference in warding off infections and lessening their severity. Patients can easily perform the most basic of these measures, such as keeping an eye on skin wounds. And as institutions like the CDC continue to educate long-term care providers about the standardized protocols for prevention and containment of the infections, MRSA in the elderly is finally receiving the serious attention it deserves.
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