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
...electing a Treatment...
...commendations for the Treatment of MRSA...
...Soft Tissue Infections (SSTI)* - Outpat...
...infections (impetigo, secondarily infected...
...es, furuncles, carbunclesIncision and...
...y for CA-MRSA purulent cellulitis (cellulitis ass...
...amycin (Cleocin®, others) Adult Dose: 300-45...
...€¡ (Bactrim®) Adult Dose: 1-2 DS ta...
...ne Adult Dose: 100 mg PO bid Pedi...
...cycline (Minocin®) Adult Dose: 200 mg...
...vox®) Adult Dose: 600 mg PO bid P...
β-hemolytic streptococci purulent cellulitis (c...
...y for β-hemolytic streptococci and f...
...cephalexin,‡ dicloxacillin) Adult Dose:...
..., amoxicillin) and ‡TMP-SMX‡ (Bactrim®) or a...
...®) Adult Dose: 600 mg PO bid Pediatric Dos...
...ycin Cleocin®, others) Adult Dose: 30...
...Tissue Infections (SSTI)* - Inpatients...
...ted SSTI (patients with deeper sof...
...debridement and antibiotics Treat for 7-14 d...
...fosamil (Teflaro®) was FDA approved for ‡...
VancomycinठAdult Dose: 15-20 mg/kg/d...
...id (Zyvox®) Adult Dose: 600 mg PO/IV bid...
...€¡ (Cubicin®) Adult Dose: 4 mg/kg/dose IV...
...ancin‡ (Vibativ®) Adult Dose: 10 m...
...Cleocin®, others) Adult Dose: 600 mg PO/I...
...rent SSTIPlease see Management of R...
...neumoni...
...A therapy is recommended for severe comm...
...ICU, necrotizing or cavitary infiltrates,...
...Treatment of HA-MRSA or CA-MRSA pneumonia...
...comycinठAdult Dose: 15-20 mg/kg/dose IV q8-...
...lid (Zyvox®) Adult Dose: 600 mg PO/IV bid...
...in (Cleocin®, others) Adult Dose: 60...
Bacteremia and Infective Endocarditi...
...eremia||
...clinical assessment to identify the so...
...mycinठAdult Dose: 15-20 mg/kg/dose...
...(Cubicin®) Adult Dose: 6 mg/kg/dose IV da...
...istent bacteremiaPlease see Persist...
...fective endocarditis, nat...
...aluation for valve replacement surgery i...
...arditis, prosthetic valveVancomycinâ...
...vous System Infections...
Meningitis
...shunt infection, shunt removal is recomme...
...ntibiotic Treat...
...ancomycinठAdult Dose: 15-20 mg/kg/dos...
...x®) Adult Dose: 600 mg PO/IV bid Pediatric...
...‡ (Bactrim®) Adult Dose: 5 mg/kg/d...
...ommend the addition of rifampin 600 mg dail...
...cess, subdural empyema, spinal epidural...
Neurosurgical evaluation for incision...
...ntibiotic Treat...
...nठAdult Dose: 15-20 mg/kg/dose IV q8-12h...
...yvox®) Adult Dose: 600 mg PO/IV bid Pedia...
...€¡ (Bactrim®) Adult Dose: 5 mg/kg/do...
Some experts recommend the addition of rifampin 60...
...thrombosis of cavernous or dural venou...
...ical evaluation for incision and draina...
...tibiotic Treat...
...mycinठAdult Dose: 15-20 mg/kg/dose IV...
...lid (Zyvox®) Adult Dose: 600 mg PO/IV bid...
...X‡ (Bactrim®) Adult Dose: 5 mg/kg/dose PO/I...
...ommend the addition of rifampin 600 mg dai...
...e and Joint Infections...
...omyelitis...
...debridement and drainage of associated s...
...dults for ≥ 8 weeks; ( A , II )659...
...or 4-6 weeks. If no debridement, continue for 1...
...ntibiotic Treat...
...comycinठAdult Dose: 15-20 mg/kg/dose...
Daptomycin‡ (Cubicin®) Adult Do...
...inezolid (Zyvox®) Adult Dose: 600...
...leocin®, others) Adult Dose: 60...
...(Bactrim®) and rifampin Adult D...
...me experts recommend the addition of rifampi...
...gnetic resonance imaging (MRI) with gadolinium i...
Erythrocyte sedimentation rate (ESR...
...c arthritis
...e or debridement of the joint space...
...tibiotic Treatme...
...¡Â§ Adult Dose: 15-20 mg/kg/dose IV q8-12h P...
...in‡ (Cubicin®) Adult Dose: 6 mg/kg/day IV...
...ox®) Adult Dose: 600 mg PO/IV bid...
...(Cleocin®, others) Adult Dose: 600 mg PO/IV ti...
...Bactrim®) Adult Dose: 3.5--4 mg/kg/dose PO/IV...
...vice-related Osteoarticular Infection...
Early-onse...
...sthetic joint infections, unstable implants...
...et spinal implant infections (≤30 days after sur...
...l implant infections (>30 days after...
...oral suppressive antibiotics (eg, TMP-SMX...
...ils please see antibiotic recommendations for...
...OTE: The use of rifampin as a single agent or a...
...abscesses and other purulent SSTI are recomm...
...Adjust dose for renal impairment â€...
...ose. In seriously ill patients consider a l...
...to the potential emergence of fluoroquinolone resi...
...n the extent of disease and the patie...
...lood cultures 2-4 days after initial p...
...Conditions in which Antimicrobial T...
...ent of Recurrent MRSA Skin and Soft Ti...
...g wounds covered with clean, dry banda...
...personal hygiene with regular bathing and...
...sing or sharing personal items (eg, ra...
...ng efforts on high-touch surfaces that may con...
...lly available cleaners or detergents appropriat...
...lops a recurrent SSTI despite optimizi...
...transmission is occurring among household me...
...sal decolonization with mupirocin t...
...lonization with mupirocin twice daily fo...
...antimicrobial therapy is recommended for the treat...
...in combination with rifampin, if susceptible,...
Personal and environmental hygiene measures in...
...ptomatic contacts should be evaluat...
...nd topical body decolonization strategies may be...
...res prior to decolonization are NOT routinely reco...
...eillance cultures following a decolonizatio...
...Infections in Neonates...
...eonatal pustulos...
For mild cases with localized diseas...
...sease in a premature or very low bir...
...atal MRSA sepsis...
...vancomycin is recommended, dosing as o...
...linezolid are alternatives for non-endov...
...mycin Monitoring...
Trough vancomycin concentrations are the most accu...
...concentrations should be obtained at steady state...
...ous infections such as bacteremia, infective e...
...patients with SSTI who have normal renal fun...
...mycin monitoring is recommended fo...
...inuous infusion vancomycin regimens are...
...cy and safety of targeting trough concentrati...
...mycin Susceptibility Testing...
...onsiderable variability in MIC results dependin...
...solates with a vancomycin MIC ≤2, eg,...
...r isolates with a vancomycin MIC > 2 mcg/mL...
...nt MRSA Bacteremia and Vancomycin Treatment Fa...
...h for and removal of other foci of infection,...
...daptomycin, if the isolate is susceptibl...
...f reduced susceptibility to vancomycin and dapto...