Methicillin-Resistant Staphylococcus Aureus (MRSA): Difference between revisions
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Revision as of 08:02, 4 March 2014
Background
Suspect MRSA infection/carrier in patients who present with:
- multiple skin sites
- recurrent infection
- pt who has been in close contact of person with Hx of MRSA
- infection showing early necrosis
- two kinds: hospital acquired and community acquired
- Hospital acquired tends to be multi-drug resistant, most commonly seen in ventilator associated pneumonia, post operative infections, and catheter associated infections
- Community acquired tends to be resistant to beta-lactams, most commonly seen in soft tissue infections and rarely in necrotizing pneumonia
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
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
- Cephalexin + Bactrim DS
- I&D if abscess
- (antibiotics not needed if no e/o cellulitis)
Antibiotic Sensitivities[1]
Organisms | ' | 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
- 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
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See Also
Source
- EBmedicine.net
References
- ↑ Sanford Guide to Antimicrobial Therapy 2010