Methicillin-Resistant Staphylococcus aureus (MRSA)
Key Points
Key Points
- Methicillin-resistant Staphylococcus aureus (MRSA (MRSA) is a significant cause of both healthcare (HA-MRSA) and community-associated
(CA-MRSA) infections with an enormous clinical and economic impact. - MRSA causes a wide spectrum of illness including skin and soft tissue infections (SSTIs), bacteremia and endocarditis, pneumonia, bone and joint infections, central nervous system disease, toxic shock and sepsis syndromes.
- The management of all MRSA infections should include identification, elimination and/or debridement of the primary source and other sites of infection when possible (eg, drainage of abscesses, removal of central venous catheters, debridement of osteomyelitis, etc.).
- In patients with MRSA bacteremia, follow-up blood cultures 2-4 days
after initial positive cultures and as needed thereafter are recommended to document clearance of bacteremia. - To optimize serum trough concentrations in adult patients, vancomycin should be dosed according to actual body weight (15-20 mg/kg/dose every 8-12 hours), not to exceed 2 grams per dose. Trough monitoring is recommended to achieve target concentrations of 15-20 mcg/mL in patients with serious MRRSA infections and to ensure target concentrations in those who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution. The efficacy and safety of targeting higher trough concentrations in children requires further study but should be considered in those with severe sepsis or persistent bacteremia.
- When an alternative to vancomycin is being considered for use, in vitro susceptibility should be confirmed and documented in the medical record.
- For methicillin-sensitive S. aureus (MSSA) infections, a β-lactam antibiotic is the drug of choice in the absence of allergy.
Photo - MRSA
Selecting a Treatment Regimen
...ing a Treatment Regimen...
...ecommendations for the Treatment of MRSA...
Skin and Soft Tissue Infections (SSTI)* - Ou...
...infections (impetigo, secondarily infected ski...
...scesses, furuncles, carbunclesIncision and dr...
...for CA-MRSA purulent cellulitis (cellu...
...leocin®, others) Adult Dose: 300-4...
TMP-SMX‡ (Bactrim®) Adult Dose: 1-2...
...ult Dose: 100 mg PO bid Pediatric Dose: 45 kg: a...
...Minocin®) Adult Dose: 200 mg x...
...inezolid (Zyvox®) Adult Dose: 600 mg PO bid...
...treptococci purulent cellulitis (cellulitis a...
...piric therapy for β-hemolytic str...
β-lactam (eg, cephalexin,‡ dicloxacillin)...
...²-lactam (eg, amoxicillin) and ‡TMP-SMXâ€...
...ezolid (Zyvox®) Adult Dose: 600...
...damycin Cleocin®, others) Adult D...
...t Tissue Infections (SSTI)* - Inpatient...
...d SSTI (patients with deeper soft tis...
...idement and antibiotics Treat for 7-14 da...
...osamil (Teflaro®) was FDA approved f...
...inठAdult Dose: 15-20 mg/kg/dose IV q8-12h...
...(Zyvox®) Adult Dose: 600 mg PO/IV bid Ped...
...(Cubicin®) Adult Dose: 4 mg/kg/dose IV...
...elavancin‡ (Vibativ®) Adult Dose: 10...
...eocin®, others) Adult Dose: 600 mg PO/IV...
...t SSTIPlease see Management of Recurrent M...
Pneumon...
...SA therapy is recommended for severe comm...
..., necrotizing or cavitary infiltrates...
...atment of HA-MRSA or CA-MRSA pneumonia...
...comycinठAdult Dose: 15-20 mg/kg/dose...
...x®) Adult Dose: 600 mg PO/IV bid...
...damycin (Cleocin®, others) Adult Dose: 600...
...teremia and Infective Endoc...
...eremia||...
...ical assessment to identify the source and ext...
...ठAdult Dose: 15-20 mg/kg/dose...
...¡ (Cubicin®) Adult Dose: 6 mg/kg/dose IV dail...
...stent bacteremiaPlease see Persiste...
...ive endocarditis, native val...
Evaluation for valve replacement surg...
Infective endocarditis, prosthetic valve...
...ral Nervous System Inf...
Meningit...
For CNS shunt infection, shunt removal...
...ibiotic Treatm...
VancomycinठAdult Dose: 15-20 mg/kg/dose I...
...®) Adult Dose: 600 mg PO/IV bid Pediatric Dos...
...actrim®) Adult Dose: 5 mg/kg/dose PO/IV q...
...recommend the addition of rifampin 600 m...
Brain abscess, subdural empyema, spinal...
...eurosurgical evaluation for incision and...
...tibiotic Treatment...
...nठAdult Dose: 15-20 mg/kg/dose IV q8-12...
...vox®) Adult Dose: 600 mg PO/IV...
...ctrim®) Adult Dose: 5 mg/kg/dose...
...recommend the addition of rifampin 600...
...is of cavernous or dural venous sinus...
...aluation for incision and drainage of contiguous s...
...otic Treatment...
...Adult Dose: 15-20 mg/kg/dose IV q8-12h Pedi...
...®) Adult Dose: 600 mg PO/IV bid Ped...
TMP-SMX‡ (Bactrim®) Adult Dose: 5 mg/kg...
...erts recommend the addition of rifampin 600 mg...
...e and Joint Infecti...
...teomyelitis
...gical debridement and drainage of associated...
...for ≥ 8 weeks; ( A , II )659
...ren for 4-6 weeks. If no debridement,...
Antibiotic Trea...
...ncomycinठAdult Dose: 15-20...
Daptomycin‡ (Cubicin®) Adult Dos...
...vox®) Adult Dose: 600 mg PO/IV bid Ped...
...damycin (Cleocin®, others) Adult Do...
...-SMX‡ (Bactrim®) and rifampin...
...ts recommend the addition of rifam...
...gnetic resonance imaging (MRI) with gadoli...
...rythrocyte sedimentation rate (ESR) and/or C...
...c arthritis...
...bridement of the joint space should always be perf...
...otic Treatment...
...mycinठAdult Dose: 15-20 mg/kg/dose I...
...ptomycin‡ (Cubicin®) Adult Dos...
...yvox®) Adult Dose: 600 mg PO/IV bid Ped...
...(Cleocin®, others) Adult Dose: 600 m...
TMP-SMX‡ (Bactrim®) Adult Dose: 3.5--4 mg/kg...
...ated Osteoarticular Infections...
...ly-onset (...
...prosthetic joint infections, unstable implants o...
...nal implant infections (≤30 days after surg...
...t spinal implant infections (>30 days after surg...
...uppressive antibiotics (eg, TMP-SMX¶, a tet...
...details please see antibiotic recomm...
...OTE: The use of rifampin as a single age...
...res from abscesses and other purulent SSTI are rec...
...st dose for renal impairment – see...
...2 gm/dose. In seriously ill patients...
...e to the potential emergence of fluoroquinolo...
...he extent of disease and the patie...
...cultures 2-4 days after initial positive c...
...dix 1. Conditions in which Antimicrobial...
Management of Recurrent MRSA Skin and Soft T...
...unds covered with clean, dry bandages. ( A ,...
...od personal hygiene with regular bathing and clea...
...oid reusing or sharing personal items (eg, ra...
...g efforts on high-touch surfaces that may contact...
...ommercially available cleaners or det...
...patient develops a recurrent SSTI despite optimizi...
...ransmission is occurring among household memb...
...ization with mupirocin twice daily for 5-10...
...lonization with mupirocin twice daily...
...crobial therapy is recommended for the treatment...
...nt in combination with rifampin, if suscept...
...and environmental hygiene measures...
...tic contacts should be evaluated for evidence of S...
...topical body decolonization strategies may be...
...reening cultures prior to decolonization are NOT...
...rveillance cultures following a decolonization...
...RSA Infections in N...
...natal pustulosis...
...es with localized disease, topical tr...
...ized disease in a premature or very low birthweig...
...natal MRSA sepsis...
...vancomycin is recommended, dosing as...
...and linezolid are alternatives for non-endov...
Vancomycin Mon...
...omycin concentrations are the most accurate...
...concentrations should be obtained at steady state...
...ous infections such as bacteremia, infe...
...patients with SSTI who have normal renal function...
...vancomycin monitoring is recommende...
...sion vancomycin regimens are not recomme...
...cacy and safety of targeting trough concentr...
...n Susceptibility Testing...
...considerable variability in MIC resul...
...with a vancomycin MIC ≤2, eg, “susceptibleâ...
...solates with a vancomycin MIC > 2 mcg/mL, eg,...
...Bacteremia and Vancomycin Treatment F...
...removal of other foci of infection, drainage or s...
...daptomycin, if the isolate is susceptible,...
...susceptibility to vancomycin and daptomycin are...