Understanding MDROs and MRSA: What are they? Why should we care? How does it affect the elderly's health?

In the wake of the COVID-19 pandemic, a concerning trend has emerged: the rise of multi-drug resistant organisms (MDROs) on a global scale. The "Communicable Diseases Watch" report from July to August 2023 highlights a stark increase in infections and colonization by formidable pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Hong Kong, a microcosm of this global challenge, has seen a dramatic rise in emerging MDRO carriers transitioning from public hospitals to Residential Care Homes for the Elderly (RCHEs)—a surge from 339 cases in 2020 to an alarming 1,270 cases by July 2023.

Amidst this backdrop, a six-year study of antibiogram data from private hospitals in Hong Kong (2014-2019) offers a silver lining: MRSA prevalence has remained steady at around 20%. But what does this mean for our most vulnerable populations, particularly the elderly? Let's delve into the significance of MDROs and MRSA, and understand why their management is critical for public health.

Undestanding the Threat: MDROs and MRSA

MDROs are pathogens that have developed resistance to multiple antimicrobial agents, making infections challenging to treat. MRSA, a notorious MDRO, is impervious to a range of antibiotics, including those in the beta-lactam family like penicillins and cephalosporins.

In fact, MRSA is a strain of the common bacterium Staphylococcus aureus, which in its typical form, is relatively harmless and can be found on the skin and in the noses of healthy people. However, when it mutates into MRSA, it develops resistance to methicillin and related antibiotics, making infections difficult to treat. MRSA can cause a range of ailments, from minor skin infections to severe conditions such as pneumonia or bloodstream infections.

The Risk of MDRO and MRSA infection is Heightened for:

• Those with a weakened immune system (which may occur in people with chronic diseases, cancer, preterm infants) or broken skin

• Those are staying in a hospital or residential care homes

• Those with invasive medical devices like a feeding tube, central venous line, or urinary catheter

• Those have recent antibiotic use

Why is MRSA widespread?

The prevalence of MRSA is due to several factors. This bacteria may be spread through sharing personal objects such as towels and razors or through close personal contact. You can develop a MRSA infection if MRSA enters your body and spreads. Moreover, the overuse and misuse of antibiotics have contributed to the rise of antibiotic-resistant bacteria like MRSA. The bacteria's ability to survive on surfaces and be transmitted through direct contact with wounds, discharge and soiled areas. In other words, it can spread quickly in places where people are in close quarters, such as hospitals, nursing homes, and other communal living spaces. Additionally, the global nature of travel and trade means that MRSA is not confined by geographic borders, making it a worldwide concern.

Impact on Public Health and the Elderly

The impact of MRSA on public health systems and the wellbeing of patients is profound. Infections can lead to longer hospital stays, increased medical costs, and a higher burden on healthcare resources.

For individuals, MRSA infections can be painful, debilitating, and, in severe cases, life-threatening. The challenge of treating MRSA infections due to their resistance to antibiotics means that prevention and control are critical components of healthcare strategies.

How does it affect elderly's health?

For the elderly, the stakes are even higher, especially they are frequent visitors to the hospitals. The elderly are also more likely to have chronic health conditions that can complicate and exacerbate the effects of MRSA. Infections in older adults can lead to rapid declines in health, prolonged recovery times, and a greater risk of mortality. The psychological and emotional stress associated with infections can also impact the overall quality of life for the elderly and their families.

In conclusion, MRSA is more than a healthcare buzzword; it’s a growing challenge that demands attention and action, particularly when it comes to protecting the health of our elderly population. By understanding its nature, transmission, and impact is crucial for developing effective preventive measures to protect our community, particularly the senior citizens, from this resilient adversary.

Further information about MRSA prevention could be found on the webpage of Centre for Health Protection

Sources: https://www.hkmj.org/system/files/hkmj219806.pdf ; https://www.chp.gov.hk/files/pdf/cdw_v19_6.pdf ; https://www.hkmj.org/abstracts/v24n4/350.htm#:~:text=Prevalence%20of%20MRSA%20was%20estimated,MRSA%20carriage%20with%20borderline%20significance.