Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA)

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Background

Background

Risk Factors

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

Treatment

  1. Antibiotics
    1. Cephalexin + Bactrim DS
      1. Estimated 95-100% sensitivity of CA-MRSA
    2. Clindamycin
      1. Approximately 50% sensitivity to CA-MRSA
      2. Inducible resistance by erythromycin in laboratory, unclear significance
    3. doxycycline
      1. Contraindicated in pregnant females and children due to deposition in teeth and bones
    4. Vancomycin IV if severe infection/sepsis
    5. Linezolid
      1. Indicated in severe soft tissue infections and pneumonia thought to be caused by CA-MRSA or HA-MRSA
  2. I&D if abscess
    1. (antibiotics not needed if no e/o cellulitis)


Antibiotic Sensitivities[1]

Category Antibiotic CA-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 I
Ofloxacin X1
Pefloxacin X1
Levofloxacin I
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 X1
Tobramycin X1
Amikacin X1
Chloramphenicol X1
Clindamycin I
Macrolides Erythromycin I
Azithromycin I
Clarithromycin I
Ketolide Telithromycin I
Tetracyclines Doxycycline S
Minocycline S
Glycylcycline Tigecycline S
Daptomycin S
Glyco/Lipoclycopeptides Vancomycin S
Teicoplanin S
Telavancin S
Fusidic Acid S
Trimethoprim S
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

Table Overview

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014