Methicillin-Resistant Staphylococcus Aureus (MRSA): Difference between revisions

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==Background==
{{MRSA background}}
*'''Two kinds:'''
**Hospital acquired (MRSA)
***Multi-drug resistant, most commonly seen in ventilator associated pneumonia, post operative infections, and catheter associated infections
**Community acquired (see CA-MRSA)
***Tends to be resistant to [[beta-lactams]], most commonly seen in [[Skin and Soft Tissue Infections]] and rarely in necrotizing [[pneumonia]]
 
===Risk Factors===
#multiple skin sites
#recurrent infection
#pt who has been in close contact of person with Hx of MRSA
#infection showing early necrosis
 
==Treatment==
# Antibiotics
## [[Cephalexin]] + [[Bactrim DS]]
###Estimated 95-100% sensitivity of CA-MRSA
## [[Clindamycin]]
###Approximately 50% sensitivity to CA-MRSA
###Inducible resistance by erythromycin in laboratory, unclear significance
## doxycycline
###Contraindicated in pregnant females and children due to deposition in teeth and bones
## [[Vancomycin]] IV if severe infection/sepsis
##Linezolid
###Indicated in severe soft tissue infections and pneumonia thought to be caused by [[CA-MRSA]] or HA-[[MRSA]]
# [[I&D]] if [[abscess]]
##(antibiotics not needed if no e/o [[cellulitis]])
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Organisms'''
| align="center" style="background:#f0f0f0;"|''''''
| align="center" style="background:#f0f0f0;"|'''Staph. aureus (MRSA)'''
|-
| Penicillins||Penicillin G||0
|-
| ||Penicillin V||0
|-
| Anti-Staphylocccal Penicillins||Methicillin||0
|-
| ||Nafcillin/Oxacillin||0
|-
| ||Cloxacillin/Diclox.||0
|-
| Amino-Penicillins||AMP/Amox||0
|-
| ||Amox/Clav||0
|-
| ||AMP-Sulb||0
|-
| Anti-Pseudomonal Penicillins||Ticarcillin||0
|-
| ||Ticar-Clav||0
|-
| ||Pip-Taxo||0
|-
| [[Carbapenems]]||Piperacillin||0
|-
| ||Doripenem||0
|-
| ||Ertapenem||0
|-
| ||Imipenem||0
|-
| ||Meropenem||0
|-
| ||[[Aztreonam]]||0
|-
| [[Fluroquinolones]]||[[Ciprofloxacin]]||0
|-
| ||Ofloxacin||0
|-
| ||Pefloxacin||0
|-
| ||[[Levofloxacin]]||0
|-
| ||Moxifloxacin||+/-
|-
| ||Gemifloxacin||+/-
|-
| ||Gatifloxacin||+/-
|-
| 1st G [[Cephalosporin]]||Cefazolin||0
|-
| 2nd G.  [[Cephalosporin]]||[[Cefotetan]]||0
|-
| ||Cefoxitin||0
|-
| ||Cefuroxime||0
|-
| 3rd/4th G.  [[Cephalosporin]]||[[CefoTAXime]]||0
|-
| ||Cefizoxime||0
|-
| ||[[CefTRIAXone]]||0
|-
| ||Ceftobiprole||+
|-
| ||Ceftaroline||+
|-
| ||[[CefTAZidime]]||0
|-
| ||[[Cefepime]]||0
|-
| Oral 1st G.  [[Cephalosporin]]||Cefadroxil||0
|-
| ||[[Cephalexin]]||0
|-
| Oral 2nd G.  [[Cephalosporin]]||Cefaclor/Loracarbef||0
|-
| ||Cefproxil||0
|-
| ||Cefuroxime axetil||0
|-
| Oral 3rd G.  [[Cephalosporin]]||Cefixime||0
|-
| ||Ceftibuten||0
|-
| ||Cefpodox/Cefdinir/Cefditoren||0
|-
| [[Aminoglycosides]]||[[Gentamicin]]||0
|-
| ||Tobramycin||0
|-
| ||[[Amikacin]]||0
|-
| ||Chloramphenicol||0
|-
| ||[[Clindamycin]]||0
|-
| [[Macrolides]]||Erythromycin||0
|-
| ||[[Azithromycin]]||0
|-
| ||Clarithromycin||0
|-
| Ketolide||Telithromycin||0
|-
| Tetracyclines||[[Doxycycline]]||+/-
|-
| ||Minocycline||+/-
|-
| Glycylcycline||Tigecycline||+
|-
| Glyco/Lipoclycopeptides||[[Vancomycin]]||+
|-
| ||Teicoplanin||+
|-
| ||Telavancin||+
|-
| ||Fusidic Acid||+
|-
| ||Trimethoprim||+/-
|-
| ||[[TMP-SMX]]||+
|-
| Urinary Agents||[[Nitrofurantoin]]||+
|-
| ||Fosfomycin||
|-
| Other||[[Rifampin]]||+
|-
| ||[[Metronidazole]]||0
|-
| ||Quinupristin dalfoppristin||+
|-
| ||Linezolid||+
|-
| ||[[Daptomycin]]||+
|-
| ||Colistimethate||0
|}
 
===Key===
{{Template:Antibacterial Spectra Key}}
 
 
==Prevention==
# good hand hygiene
# avoid sharing personal items with carriers
# wash common household items with bleach and hot water
# wash soiled sheets, towels, clothes in hot water with bleach and dry in hot dryer
# Eradicate carriers:
##mupirocin 2%: apply to each nostril TID x 5days
## Hibiclens wash daily x 5 days
## consider oral antibiotics 


==Management==
*Treatment/resistance is different for each type; check specific page


==Table Overview==
==Table Overview==
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*[[Staph. aureus]]
*[[Staph. aureus]]


==Source==
==References==
*EBmedicine.net


==References==
==References==
<references/>
<references/>
[[Category:ID]]
[[Category:ID]]

Latest revision as of 21:30, 10 September 2017

Background

Risk Factors

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

Management

  • Treatment/resistance is different for each type; check specific page

Table Overview

See Also

References

References