The Nose – “Ground Zero” for MRSA colonization

Staphylococcus aureus is a pretty versatile bug, meaning it dedicates a lot of its time and resources to developing ways to live happily on all kinds of tissue surfaces. As you’ve probably heard, we all have bacteria living all over on us and in us at all times. From the time you eat your first meal, you’ve got them throughout your digestive tract, and even earlier than that every inch of your skin is covered with bacterial cells. Fun fact – you have far, far more bacterial cells associated with you than you actually have of your own cells (by about 10 to 1)!

Bacteria generally live on the skin by attaching to receptors on the epithelial cell layer at the outermost skin surface. MRSA/S. aureus is particularly good at competing for these limited binding spaces. Scientists believe that your genetic make-up also has something to do with how well this bacteria likes you, which is why about 30-40% of people are permanently colonized with S. aureus, while the rest are either just transient or non-carriers. By the way, being a non-carrier doesn’t mean that you’re free of bacteria…it just means that your skin is better suited to some other type of bacteria and you’ve got that living on you instead.

Now, to further complicate the story, research studies are showing that even amongst permanent carriers of MRSA/S. aureus there can be big differences in colonization characteristics. While the inside of the nose is commonly accepted to be a major colonization site for MRSA, nasal carriers may or may not have the bacteria at other body sites including the throat, groin, armpits, and perineum. Finding MRSA in any combination of these places does not guarantee that it will be present at other sites if tested, so there really is no good way to predict how much someone is colonized without taking samples from many different areas. And why do we care about the extent of MRSA colonization? The answer, as I addressed in a previous entry, is that there’s a strong correlation between colonization and the development of subsequent infections.

A new study, published online ahead of print this month in the Journal of Clinical Microbiology, takes perhaps the closest look to date at sites of MRSA colonization on the human body.1 This work, funded by 3M Healthcare, looked at MRSA carriage in 60 patients admitted to Rhode Island Hospital over a 1-year period. Skin swab samples were taken from the nose, groin, perineum, and axilla (armpit). Because all the patients in the group evaluated had been previously identified as MRSA carriers at one time or another, 88% of them were confirmed to be positive in at least one site during this study. In this subset of carriers, it was found that an overwhelming majority (91%) were positive for MRSA in nasal samples. Furthermore, almost 25% had MRSA in the nose but not at any other body site sampled – making the nose the highest of any single anatomical colonization site. Finally, positive samples from the nose were found to contain higher numbers of MRSA cells as compared to positive samples from the other body sites. These findings led the investigators to conclude that the nose has the highest sensitivity of any single site for determining MRSA colonization, and that the greater the numbers of MRSA isolated from the nose, the higher the chance of finding colonization at other body sites as well.

 While screening patients for MRSA colonization is showing promise as far as reducing hospital-acquired infections, the major barriers to adoption are cost and extra workload associated with putting a screening program in place. Taking a single sample from each patient is burden enough, without even thinking about multiple samples from different body sites. Understanding that the nose is the single greatest “hotzone” for MRSA is important in allowing infection control doctors to develop screening protocols that create the lowest drain on resources. The other alternative would be to simply decolonize all patients entering the hospital, understanding that up to 40% of them are carrying some strain of S. aureus anyway that increases their risk of infection. This approach would require a decolonization treatment that is fast-acting, low cost, and doesn’t lead to the creation of resistant bacterial populations like current antibiotics. More on that concept in an upcoming post…

1 Mermel LA et al. (2011) Methicillin-Resistant Staphylococcus aureus (MRSA) colonization at different body sites: A prospective, quantitative analysis. Journal of Clinical Microbiology, published online ahead of print on 5 January 2011.

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22 Responses to “The Nose – “Ground Zero” for MRSA colonization”

  1. Rhonda says:

    Personally, I believe that all high risk patients should be screened for colonization. As a double hip resurfacing patient, a simple test would have saved me immeasurable suffering.

    I’m not sure of the cost, but one thing is for sure – the subsequent, long-term care I required would have paid for a lot of screening tests!

    - 2 additional surgeries
    - 4 months of IV antibiotics, anti-nausea meds, pain medication, etc. Including drugs brought in especially for me, only to find out I was allergic. We went through 5 antibiotics.
    - 16 weeks of a PICC line – 2 replacements – one after a 10cc blood clot came through the PICC line!
    - 6 weeks of hospitalization in isolation
    - 4 blood transfusions
    - 16 weeks of daily home nurse visits
    - 4 weeks of daily visits from the ortho surgeon and the infectious disease specialist
    - consult visits with the hematologist
    - daily blood work, sometimes more than once a day
    xrays, CT scans, MRIs
    …..and on and on and on!

    One simple MRSA screening test would have found I was colonized with MRSA, likely from anyone of my 5 previous surgeries. I would have been decolonized and there is a good chance that none of that would have been necessary. And I am one of the lucky ones – this infection can and does kill.

  2. Pat Osborn says:

    I am battling staph aureus for the 9th month (in my heel following the removal of a heel spur). Vancomycin is not helping to kill the infection. The treatment is extremely expensive and I take pain killers when needed. Yet I do not have MRSA. I too have recurrent MRI’s, weekly blood tests, xrays, PICC line specialists, etc. I don’t know what is next for me but I hope whatever it is will stop this pervasive infection!

  3. Carol says:

    I believe better teaching,within the medical community, should be done.
    -Known carriers are discharged home from the hospital. Most thinking they are cured or no longer colonized. They spread the MRSA bacteria by touch doing the activities of daily living.
    -Family members of colonized patients should be informed that they should be screened for MRSA and treated if necessary. If not the cycle continues to repeat itself.

    Slightly off the topic.
    My biggest worry is seeing children brought into the hospital to visit an ill patient. Although I understand the need to visit. I believe a minimum age requirement should be mandatory to protect the little ones we cherish.
    We should be thinking of decreasing their exposure to any bacteria!

  4. Joan says:

    MRSA is an airborne pathogen so many people have it in their nose when swabbed. Many still do not believe that. There are several reports that verify this information. In 2001 Japan did a study and discovered it was airborne. There are several other studies that confirm this finding.

  5. carol says:

    I have 2 episodes of MRSA. one in the humerus and that cause d severe muscle damage resulting in 2 yrs + of therapy. which with alot of very hard work I ‘ve gotten the use of my arm back. then in ankle , again the wound vac was used , at home vanco , PICC line for 4 months , plus various other medications as mentioned above by Rhonda .
    I was a nurse and back in the early 90′s MRSA patients were keep away from other patients , you have to wear mask , gown , gloves. etc. seems that we took it for granted , mixing MRSA patients in with the other patients, nurses dragging it from room to room. no more were gown required. they should check everyone pre=op or those coming in ER’s , perhaps they can save $$$$$$ , peoples lives and pain and suffering involved in this awful bug .

  6. Holly says:

    Bleach baths will kill it topically and keep it away!! One cup of bleach in your bath water!!! My son was on antibiotics for his severe eczema and had MRSA for about 4 years before a dr. in St. Louis told us to stop all antibiotics and do the bleach baths. He rarely gets MRSA, we use it as a preventative about once a week now…

  7. Joan says:

    MRSA an airborne pathogen – Aerobiological Engineering Handbook Wladyslaw Jan Kowalski Pages -537 & 779 I think you will find this book very enlightening.

  8. Andrea says:

    Amazing how much predujudice I encountered because of M.R.S.A. I was the sole caregiver for a very ill husband was kicked out of my obstatricians office (with a mask) when they found out my husband was positive even though I was not. He was not allowed to attend the birth of our child because they would have had to “completely steriliize the entire elevator he rode in” and the room I was in if he was allowed to attend. Completely rediculous. Being my husband I was around him continuously and being his sole caregiver I was constantly in touch with bodily fluids (much more than anyone would have been exposed in an elavator) and suprise suprise He has now been deceased for four years and I still test negative.

  9. Stormie says:

    I have had 4 occurrences of MRSA on my stomach almost leading to my death in December of 2010. I was admitted into a small hospital and given IV antibiotics for 3 days and then after a surgeon who seemed to know nothing about MRSA decided that the place on my stomach didn’t need to be opened up and sent me home I began to get a very high fever. I sent a picture of the infection to a friend who was an infectious disease doctors office in Arizona. He told me to go to a larger hospital ASAP. At the smaller hospital I had returned to the ER and was treated like a drug seeker. At the larger hospital in the Dallas area I was opened up immediatly and told that I was septic on the verge of death. After receive more antibiotics and cleaning the wound I felt ten times better. I was then sent to an infectious disease doctor and decolonized. I have had one small outbreak since then but have all the tools for decolonization. The doctors and my friend saved my life. ER staff are so undereducated on MRSA that they are going to end up killing some patients.

  10. Dion says:

    The focus here should be on the optimization and development of antibacterial therapeutics. The notion that bacterial infections can be prevented or that screening for MRSA is going to reduce infection is shortsighted.

    It is no secret that these bacteria colonize the skin. The reasons we are seeing more troublesome infections is due to the lack of novel therapeutics. Re-sensitizing bacteria is a relatively easy step if people are willing to think outside the box on this problem.

  11. Joan says:

    Photocatalytic Oxidation kills airborne pathogens such as MRSA.Hospitals need to have this technology for air purification as well as surface cleaning to reduce the chances of spreading this superbug.

  12. Maureen Fowler says:

    What is the photocatalytic oxidation process? and once it is done, can you prevent re-exposure?

  13. Decolonization is only necessary if other patients are liable to be on the receiving end. Something rarely discussed is the idea of decentralizing health care. Bacteria is far easier to manage if patients are treated away from other patients – most likely at home. Obviously it would be more expensive, so I foresee a new trend among the rich, soon – in-home treatment, with strict hygiene in return for $$$. This will most likely occur when the general public becomes aware of the bacterial risks associated with hospitalization.

  14. Janelle says:

    I have had this sore in my nose for 6 months, it will not heal, it has a nasty infected smell to it, it went from one nare to the other. So after using neosporin and silvadine cream for months, I decided to get a culture and sure enouth it is MRSA and now I am on Bactrim and Bactrobam cream, Hope it works…

  15. michelehanna says:

    My husband is now on his 4th round of mrsa, staph with big swollen open sores. He has been treated with antibiotics. His mrsa has returned each month for the past 3mos. he has had iv antibiotics also. We are so frustrated not knowing what to do to keep it from reoccuring.After testing they have found it to be in his nose, cellulitis thighs,toe and foot.

  16. [...] of MRSA in hospitals more recent years. This is especially the case after implementing universal MRSA screening in a patients nose. However, there is growing concern on the prevalence of community-acquired MRSA strains as they can [...]

  17. Judith Whitlock says:

    May I use the 2 pictures in this article in a national presentation to MRSA Prevention Coordinators in the Veterans Healthcare System? Please reply to me at my e-mail address. Thanks.

  18. estradiol says:

    There is not much of a difference between a diabetic patient and a person who consumes alcohol. Both of them are supposed to avoid consuming certain things and both of them cannot survive without it. You need to be focused and determined. Our tongue forces us to eat sweets and other junk food which we are generally supposed to avoid also in case of an alcoholic person the tongue forces him for the taste of alcohol. Having control over the tongue and mind would do good to you.

  19. Ben J. says:

    I think I have MRSA. My breathing is very difficult and the boils in my nostrils are painful.

  20. [...] aureus is a staph bacterium commonly found in the nose. In certain cases, certain strains become resistant to antibiotics, resulting in [...]

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