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

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==Source==
==Source==
Adapted from Donaldson
Adapted from Donaldson
EBmedicine.net


[[Category:ID]]
[[Category:ID]]

Revision as of 02:51, 27 October 2011

Background

Suspect MRSA infection/carrier in patients who present with:

  1. multiple skin sites
  2. recurrent infection
  3. pt who has been in close contact of person with Hx of MRSA
  4. infection showing early necrosis
  5. two kinds: hospital acquired and community acquired
    1. Hospital acquired tends to be multi-drug resistant, most commonly seen in ventilator associated pneumonia, post operative infections, and catheter associated infections
    2. Community acquired tends to be resistant to beta-lactams, most commonly seen in soft tissue infections and rarely in necrotizing 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:
  6. mupirocin 2%: apply to each nostril TID x 5days
  7. Hibiclens wash daily x 5 days
  8. consider oral antibiotics

Treatment

  1. Antibiotics
    1. Keflex + 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)

Source

Adapted from Donaldson

EBmedicine.net