Hospital acquired-Methicillin-Resistant Staphylococcus Aureus (HA-MRSA)

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Background

Risk Factors

  • Multiple skin sites
  • Recurrent infection
  • Close contact of person with Hx of MRSA
  • Infection showing early necrosis

Management

  • Antibiotics
    • Vancomycin IV if severe infection/sepsis
    • Daptomycin is a poor choice for lung infection as it is inactivated by pulmonary surfactant
    • Linezolid
      • Indicated in severe soft tissue infections and pneumonia thought to be caused by CA-MRSA or HA-MRSA

Antibiotic Sensitivities[1]

Category Antibiotic HA-MRSA
Penicillins Penicillin G R
Penicillin V R
Methicillin R
Nafcillin/Oxacillin R
Cloxacillin/Diclox. R
Amino-Penicillins AMP/Amox R
Amox-Clav R
AMP-Sulb R
Anti-Pseudomonal Penicillins Ticarcillin R
Ticar-Clav R
Pip-Tazo R
Piperacillin R
Carbapenems Doripenem R
Ertapenem R
Imipenem R
Meropenem R
Aztreonam R
Fluroquinolones Ciprofloxacin R
Ofloxacin R
Pefloxacin R
Levofloxacin R
Moxifloxacin I
Gemifloxacin I
Gatifloxacin I
1st G Cephalo Cefazolin R
2nd G. Cephalo Cefotetan R
Cefoxitin R
Cefuroxime R
3rd/4th G. Cephalo Cefotaxime R
Cefizoxime R
CefTRIAXone R
Ceftaroline S
CefTAZidime R
Cefepime R
Oral 1st G. Cephalo Cefadroxil R
Cephalexin R
Oral 2nd G. Cephalo Cefaclor/Loracarbef R
Cefproxil R
Cefuroxime axetil R
Oral 3rd G. Cephalo Cefixime R
Ceftibuten R
Cefpodox/Cefdinir/Cefditoren R
Aminoglycosides Gentamicin R
Tobramycin R
Amikacin R
Chloramphenicol R
Clindamycin R
Macrolides Erythromycin R
Azithromycin R
Clarithromycin R
Ketolide Telithromycin R
Tetracyclines Doxycycline I
Minocycline I
Glycylcycline Tigecycline S
Daptomycin S
Glyco/Lipoclycopeptides Vancomycin S
Teicoplanin S
Telavancin S
Fusidic Acid S
Trimethoprim I
TMP-SMX S
Urinary Agents Nitrofurantoin S
Fosfomycin S
Other Rifampin S
Metronidazole R
Quinupristin dalfoppristin S
Linezolid S
Colistimethate R

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Prevention

  1. good hand hygiene
  2. avoid sharing personal items with carriers
  3. wash common household items with bleach and hot water
  4. wash soiled sheets, towels, clothes in hot water with bleach and dry in hot dryer
  5. Eradicate carriers:
    1. mupirocin 2%: apply to each nostril TID x 5days
    2. Hibiclens wash daily x 5 days
    3. consider oral antibiotics


Table Overview

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014