Methicillin-Resistant Staphylococcus aureus (MRSA)

Publication Date: February 1, 2011

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


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