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
...Selecting...
...Table 1. Recomm...
...Sk...
...in infections (impetigo, secondari...
..., furuncles, carbunclesIncision and drainage...
...for CA-MRSA purulent cellulitis (...
...in (Cleocin®, others) Adult Dose: 300-4...
...‡ (Bactrim®) Adult Dose: 1-2 DS tab PO bid...
...xycycline Adult Dose: 100 mg PO b...
...cycline (Minocin®) Adult Dose: 200 mg...
...d (Zyvox®) Adult Dose: 600 mg PO bid Pediatr...
...hemolytic streptococci purulent celluli...
...rapy for β-hemolytic streptococci and for ...
...(eg, cephalexin,‡ dicloxacillin) Ad...
...tam (eg, amoxicillin) and ‡TMP-SM...
...lid (Zyvox®) Adult Dose: 600 mg PO bid...
...damycin Cleocin®, others) Adult Dose:...
...Skin and...
...TIÂ (patients with deeper soft tissue infections...
Surgical debridement and antibiotics Treat f...
Ceftaroline fosamil (Teflaro®) was...
...comycinठAdult Dose: 15-20 mg/kg/dose IV...
...olid (Zyvox®) Adult Dose: 600 mg PO/I...
...n‡ (Cubicin®) Adult Dose: 4 m...
...vancin‡ (Vibativ®) Adult Dose: 1...
...eocin®, others) Adult Dose: 600 mg PO/I...
...ent SSTIPlease see Management of Recurrent...
...Pneumon...
...MRSA therapy is recommended for severe comm...
...ICU, necrotizing or cavitary infiltrates, or...
...atment of HA-MRSA or CA-MRSA pneu...
...ycinठAdult Dose: 15-20 mg/kg/dose...
...(Zyvox®) Adult Dose: 600 mg PO/IV b...
...lindamycin (Cleocin®, others) Adult Dose: 600...
...Bacteremia an...
...eremia||...
...sment to identify the source and ext...
...§ Adult Dose: 15-20 mg/kg/dose IV...
...ycin‡ (Cubicin®) Adult Dose: 6 mg/kg/dose IV...
...acteremiaPlease see Persistent MRSA...
...Infe...
...or valve replacement surgery is re...
...carditis, prosthetic valveVancomycinठAd...
Ce...
Meningitis
...hunt infection, shunt removal is recommen...
...biotic Treatment...
...Adult Dose: 15-20 mg/kg/dose IV q8-12h P...
...(Zyvox®) Adult Dose: 600 mg PO/IV...
...actrim®) Adult Dose: 5 mg/kg/dose PO/IV q8-12...
...e experts recommend the addition of rifampin...
...Brain abscess, subdural em...
...evaluation for incision and drainage is reco...
...tibiotic Treatm...
...ncomycinठAdult Dose: 15-20...
...Zyvox®) Adult Dose: 600 mg PO/IV...
...P-SMX‡ (Bactrim®) Adult Dose: 5 mg/kg/dose PO...
...commend the addition of rifampin 6...
...Septic thrombosis of...
...aluation for incision and drainage of contigu...
...ntibiotic Treatme...
...nठAdult Dose: 15-20 mg/kg/dose IV q8-12h...
...x®) Adult Dose: 600 mg PO/IV bid Ped...
TMP-SMX‡ (Bactrim®) Adult Dose: 5 mg/kg/dose...
...ommend the addition of rifampin 600 mg da...
...Bone and Join...
...Osteomyeli...
...al debridement and drainage of associated sof...
...eat adults for ≥ 8 weeks; ( A , II...
...en for 4-6 weeks. If no debridement...
...iotic Treatment...
...€ˇÂ§ Adult Dose: 15-20 mg/kg/dose...
...omycin‡ (Cubicin®) Adult Dose: 6...
...Zyvox®) Adult Dose: 600 mg PO/IV bid Pediat...
...leocin®, others) Adult Dose: 600 mg P...
...P-SMX‡ (Bactrim®) and rifampin Adult...
...me experts recommend the addition...
...gnetic resonance imaging (MRI) with...
...e sedimentation rate (ESR) and/or C-reactive pro...
...Septi...
...ridement of the joint space should always b...
...otic Treatment...
...omycinठAdult Dose: 15-20 mg/kg/dose IV q8-...
...in‡ (Cubicin®) Adult Dose: 6 mg/kg/...
Linezolid (Zyvox®) Adult Dose: 600 mg P...
...damycin (Cleocin®, others) Adult Dose:...
...SMX‡ (Bactrim®) Adult Dose: 3.5--4...
...ly-onset (...
...ate-onset prosthetic joint infections, unstable...
...set spinal implant infections (≤30 days after...
...-onset spinal implant infections (...
...g-term oral suppressive antibiotics (eg, TMP-S...
...ils please see antibiotic recommendations for de...
...: The use of rifampin as a single agent or as adj...
...abscesses and other purulent SSTI are rec...
...dose for renal impairment – see Prescrib...
...gm/dose. In seriously ill patient...
...e to the potential emergence of fl...
...€ Based on the extent of disease and the...
...| Repeat blood cultures 2-4 days after init...
...onditions in which Antimicrobial Therapy...
...Management of...
Keep draining wounds covered with clean, dry...
...good personal hygiene with regular b...
...or sharing personal items (eg, razors, li...
...us cleaning efforts on high-touch surfaces that...
...ly available cleaners or detergents appropr...
...t develops a recurrent SSTI despite opti...
...ing transmission is occurring among household me...
Nasal decolonization with mupirocin twice d...
...decolonization with mupirocin twice da...
...robial therapy is recommended for th...
...oral agent in combination with rifampin, if...
...and environmental hygiene measures in...
...matic contacts should be evaluated fo...
...nd topical body decolonization strategies...
...ltures prior to decolonization are NOT r...
...urveillance cultures following a deco...
...MRSA...
...Neonatal pustulosi...
...ild cases with localized disease, topical t...
...or localized disease in a premature or v...
...Neonatal MR...
...V vancomycin is recommended, dosing as outline...
...ndamycin and linezolid are alternatives fo...
...Vancomycin M...
...ycin concentrations are the most a...
...rough concentrations should be obtained at s...
...ctions such as bacteremia, infective e...
...t patients with SSTI who have normal r...
...rough vancomycin monitoring is recommended...
...infusion vancomycin regimens are not recom...
...cacy and safety of targeting trough concentratio...
...V...
...ere is considerable variability in MIC...
...h a vancomycin MIC ≤2, eg, “susceptible” ac...
...th a vancomycin MIC > 2 mcg/mL, eg, vancomycin-in...
...Persistent...
...arch for and removal of other foci of inf...
...dose daptomycin, if the isolate is susceptible,...
...eptibility to vancomycin and daptomycin are p...