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

Revision as of 04:35, 12 May 2014

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

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

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

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:
1. mupirocin 2%: apply to each nostril TID x 5days
2. Hibiclens wash daily x 5 days
3. consider oral antibiotics

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-Suspect MRSA infection/carrier in patients who present with:
+*'''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
-#two kinds: hospital acquired and community acquired (see [[CA-MRSA]])
-##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
 ==Treatment==
 # Antibiotics