Methicillin-Resistant Staphylococcus Aureus (MRSA): Difference between revisions
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###Indicated in severe soft tissue infections and pneumonia thought to be caused by [[CA-MRSA]] or HA-[[MRSA]]
###Indicated in severe soft tissue infections and pneumonia thought to be caused by [[CA-MRSA]] or HA-[[MRSA]]


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>==
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Organisms'''
| align="center" style="background:#f0f0f0;"|'''Category'''
| align="center" style="background:#f0f0f0;"|''''''
| align="center" style="background:#f0f0f0;"|'''Antibiotic'''
| align="center" style="background:#f0f0f0;"|'''Staph. aureus (MRSA)'''
| align="center" style="background:#f0f0f0;"|'''[[MRSA]]'''
|-
|-
| Penicillins||Penicillin G||0
| [[Penicillins]]||[[Penicillin G]]||R
|-
|-
| ||Penicillin V||0
| ||[[Penicillin V]]||R
|-
|-
| Anti-Staphylocccal Penicillins||Methicillin||0
| ||[[Methicillin]]||R
|-
|-
| ||Nafcillin/Oxacillin||0
| ||[[Nafcillin]]/[[Oxacillin]]||R
|-
|-
| ||Cloxacillin/Diclox.||0
| ||[[Cloxacillin]]/[[Diclox.]]||R
|-
|-
| Amino-Penicillins||AMP/Amox||0
| Amino-[[Penicillins]]||[[AMP]]/[[Amox]]||R
|-
|-
| ||Amox/Clav||0
| ||[[Amox-Clav]]||R
|-
|-
| ||AMP-Sulb||0
| ||[[AMP-Sulb]]||R
|-
|-
| Anti-Pseudomonal Penicillins||Ticarcillin||0
| Anti-Pseudomonal [[Penicillins]]||[[Ticarcillin]]||R
|-
|-
| ||Ticar-Clav||0
| ||[[Ticar-Clav]]||R
|-
|-
| ||Pip-Taxo||0
| ||[[Pip-Tazo]]||R
|-
|-
| [[Carbapenems]]||Piperacillin||0
| ||Piperacillin||R
|-
|-
| ||Doripenem||0
| [[Carbapenems]]||Doripenem||R
|-
|-
| ||Ertapenem||0
| ||[[Ertapenem]]||R
|-
|-
| ||Imipenem||0
| ||[[Imipenem]]||R
|-
|-
| ||Meropenem||0
| ||[[Meropenem]]||R
|-
|-
| ||[[Aztreonam]]||0
| ||[[Aztreonam]]||R
|-
|-
| [[Fluroquinolones]]||[[Ciprofloxacin]]||0
| [[Fluroquinolones]]||[[Ciprofloxacin]]||R
|-
|-
| ||Ofloxacin||0
| ||[[Ofloxacin]]||R
|-
|-
| ||Pefloxacin||0
| ||Pefloxacin||R
|-
|-
| ||[[Levofloxacin]]||0
| ||[[Levofloxacin]]||R
|-
|-
| ||Moxifloxacin||+/-
| ||[[Moxifloxacin]]||I
|-
|-
| ||Gemifloxacin||+/-
| ||Gemifloxacin||I
|-
|-
| ||Gatifloxacin||+/-
| ||Gatifloxacin||I
|-
|-
| 1st G [[Cephalosporin]]||Cefazolin||0
| 1st G [[Cephalo]]||Cefazolin||R
|-
|-
| 2nd G. [[Cephalosporin]]||[[Cefotetan]]||0
| 2nd G. [[Cephalo]]||[[Cefotetan]]||R
|-
|-
| ||Cefoxitin||0
| ||[[Cefoxitin]]||R
|-
|-
| ||Cefuroxime||0
| ||[[Cefuroxime]]||R
|-
|-
| 3rd/4th G. [[Cephalosporin]]||[[CefoTAXime]]||0
| 3rd/4th G. [[Cephalo]]||[[Cefotaxime]]||R
|-
|-
| ||Cefizoxime||0
| ||Cefizoxime||R
|-
|-
| ||[[CefTRIAXone]]||0
| ||[[CefTRIAXone]]||R
|-
|-
| ||Ceftobiprole||+
| ||Ceftaroline||S
|-
|-
| ||Ceftaroline||+
| ||[[CefTAZidime]]||R
|-
|-
| ||[[CefTAZidime]]||0
| ||[[Cefepime]]||R
|-
|-
| ||[[Cefepime]]||0
| Oral 1st G. [[Cephalo]]||Cefadroxil||R
|-
|-
| Oral 1st G.  [[Cephalosporin]]||Cefadroxil||0
| ||[[Cephalexin]]||R
|-
|-
| ||[[Cephalexin]]||0
| Oral 2nd G. [[Cephalo]]||Cefaclor/Loracarbef||R
|-
|-
| Oral 2nd G.  [[Cephalosporin]]||Cefaclor/Loracarbef||0
| ||Cefproxil||R
|-
|-
| ||Cefproxil||0
| ||Cefuroxime axetil||R
|-
|-
| ||Cefuroxime axetil||0
| Oral 3rd G. [[Cephalo]]||Cefixime||R
|-
|-
| Oral 3rd G.  [[Cephalosporin]]||Cefixime||0
| ||Ceftibuten||R
|-
|-
| ||Ceftibuten||0
| ||Cefpodox/Cefdinir/Cefditoren||R
|-
|-
| ||Cefpodox/Cefdinir/Cefditoren||0
| [[Aminoglycosides]]||[[Gentamicin]]||R
|-
|-
| [[Aminoglycosides]]||[[Gentamicin]]||0
| ||Tobramycin||R
|-
|-
| ||Tobramycin||0
| ||[[Amikacin]]||R
|-
|-
| ||[[Amikacin]]||0
| ||[[Chloramphenicol]]||R
|-
|-
| ||Chloramphenicol||0
| ||[[Clindamycin]]||R
|-
|-
| ||[[Clindamycin]]||0
| [[Macrolides]]||Erythromycin||R
|-
|-
| [[Macrolides]]||Erythromycin||0
| ||[[Azithromycin]]||R
|-
|-
| ||[[Azithromycin]]||0
| ||Clarithromycin||R
|-
|-
| ||Clarithromycin||0
| Ketolide||Telithromycin||R
|-
|-
| Ketolide||Telithromycin||0
| Tetracyclines||[[Doxycycline]]||I
|-
|-
| Tetracyclines||[[Doxycycline]]||+/-
| ||Minocycline||I
|-
|-
| ||Minocycline||+/-
| Glycylcycline||Tigecycline||S
|-
|-
| Glycylcycline||Tigecycline||+
| ||Daptomycin||S
|-
|-
| Glyco/Lipoclycopeptides||[[Vancomycin]]||+
| Glyco/Lipoclycopeptides||[[Vancomycin]]||S
|-
|-
| ||Teicoplanin||+
| ||Teicoplanin||S
|-
|-
| ||Telavancin||+
| ||Telavancin||S
|-
|-
| ||Fusidic Acid||+
| ||Fusidic Acid||S
|-
|-
| ||Trimethoprim||+/-
| ||Trimethoprim||I
|-
|-
| ||[[TMP-SMX]]||+
| ||[[TMP-SMX]]||S
|-
|-
| Urinary Agents||[[Nitrofurantoin]]||+
| Urinary Agents||[[Nitrofurantoin]]||S
|-
|-
| ||Fosfomycin||
| ||Fosfomycin||S
|-
|-
| Other||[[Rifampin]]||+
| Other||[[Rifampin]]||S
|-
|-
| ||[[Metronidazole]]||0
| ||[[Metronidazole]]||R
|-
|-
| ||Quinupristin dalfoppristin||+
| ||Quinupristin dalfoppristin||S
|-
|-
| ||Linezolid||+
| ||[[Linezolid]]||S
|-
|-
| ||[[Daptomycin]]||+
| ||Colistimethate||R
|-
| ||Colistimethate||0
|}
|}


===Key===
===Key===
{{Template:Antibacterial Spectra Key}}
{{Template:Antibacterial Spectra Key}}


==Prevention==
==Prevention==

Revision as of 06:40, 3 June 2014

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)

Risk Factors

  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

Treatment

  1. Antibiotics
    1. Vancomycin IV if severe infection/sepsis
    2. Linezolid
      1. Indicated in severe soft tissue infections and pneumonia thought to be caused by CA-MRSA or HA-MRSA

Antibiotic Sensitivities[1]

Category Antibiotic MRSA
Penicillins Penicillin G R
Penicillin V R
Methicillin R
Nafcillin/Oxacillin R
Cloxacillin/Diclox. R
Amino-Penicillins AMP/Amox R
Amox-Clav R
AMP-Sulb R
Anti-Pseudomonal Penicillins Ticarcillin R
Ticar-Clav R
Pip-Tazo R
Piperacillin R
Carbapenems Doripenem R
Ertapenem R
Imipenem R
Meropenem R
Aztreonam R
Fluroquinolones Ciprofloxacin R
Ofloxacin R
Pefloxacin R
Levofloxacin R
Moxifloxacin I
Gemifloxacin I
Gatifloxacin I
1st G Cephalo Cefazolin R
2nd G. Cephalo Cefotetan R
Cefoxitin R
Cefuroxime R
3rd/4th G. Cephalo Cefotaxime R
Cefizoxime R
CefTRIAXone R
Ceftaroline S
CefTAZidime R
Cefepime R
Oral 1st G. Cephalo Cefadroxil R
Cephalexin R
Oral 2nd G. Cephalo Cefaclor/Loracarbef R
Cefproxil R
Cefuroxime axetil R
Oral 3rd G. Cephalo Cefixime R
Ceftibuten R
Cefpodox/Cefdinir/Cefditoren R
Aminoglycosides Gentamicin R
Tobramycin R
Amikacin R
Chloramphenicol R
Clindamycin R
Macrolides Erythromycin R
Azithromycin R
Clarithromycin R
Ketolide Telithromycin R
Tetracyclines Doxycycline I
Minocycline I
Glycylcycline Tigecycline S
Daptomycin S
Glyco/Lipoclycopeptides Vancomycin S
Teicoplanin S
Telavancin S
Fusidic Acid S
Trimethoprim I
TMP-SMX S
Urinary Agents Nitrofurantoin S
Fosfomycin S
Other Rifampin S
Metronidazole R
Quinupristin dalfoppristin S
Linezolid S
Colistimethate R

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

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


Table Overview

Gram Positives
Cocci
Clusters
Pairs/Chains
Other
Rods
Gram Negatives
Cocci
Rods
Lactose Fermenters
Lactose Non-Fermenters
Other
Rods/Cocci
Anaerobes

See Also

Source

  • EBmedicine.net

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
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