Methicillin-Resistant Staphylococcus Aureus (MRSA)
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
- Keflex + 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
- Keflex + Bactrim DS
- I&D if abscess
- (antibiotics not needed if no e/o cellulitis)
Source
Adapted from Donaldson
EBmedicine.net