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| ==Background==
| | {{MRSA background}} |
| Suspect MRSA infection/carrier in patients who present with:
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| #multiple skin sites
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| #recurrent infection
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| #pt who has been in close contact of person with Hx of MRSA
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| #infection showing early necrosis
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| #two kinds: hospital acquired and community acquired (see [[CA-MRSA]]
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| ##Hospital acquired tends to be multi-drug resistant, most commonly seen in ventilator associated pneumonia, post operative infections, and catheter associated infections
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| ##Community acquired tends to be resistant to beta-lactams, most commonly seen in soft tissue infections and rarely in necrotizing pneumonia
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| ==Prevention== | | ==Management== |
| # good hand hygiene
| | *Treatment/resistance is different for each type; check specific page |
| # avoid sharing personal items with carriers
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| # wash common household items with bleach and hot water
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| # wash soiled sheets, towels, clothes in hot water with bleach and dry in hot dryer
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| # Eradicate carriers:
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| # mupirocin 2%: apply to each nostril TID x 5days
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| # Hibiclens wash daily x 5 days
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| # consider oral antibiotics
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| ==Treatment== | | ==List of MRSA Antibiotics== |
| # Antibiotics
| | {{#ask:[[Has MRSA::S]] |format=ul }} |
| ## [[Cephalexin]] + [[Bactrim DS]]
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| ###Estimated 95-100% sensitivity of CA-MRSA
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| ## [[Clindamycin]]
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| ###Approximately 50% sensitivity to CA-MRSA
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| ###Inducible resistance by erythromycin in laboratory, unclear significance
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| ## doxycycline
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| ###Contraindicated in pregnant females and children due to deposition in teeth and bones
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| ## [[Vancomycin]] IV if severe infection/sepsis
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| ##Linezolid
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| ###Indicated in severe soft tissue infections and pneumonia thought to be caused by [[CA-MRSA]] or HA-[[MRSA]]
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| # [[I&D]] if [[abscess]]
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| ##(antibiotics not needed if no e/o [[cellulitis]])
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| | |
| ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>==
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| {| class="wikitable" | |
| | align="center" style="background:#f0f0f0;"|'''Organisms'''
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| | align="center" style="background:#f0f0f0;"|''''''
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| | align="center" style="background:#f0f0f0;"|'''Staph. aureus (MRSA)'''
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| |-
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| | Penicillins||Penicillin G||0
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| |-
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| | ||Penicillin V||0
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| |-
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| | Anti-Staphylocccal Penicillins||Methicillin||0
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| |-
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| | ||Nafcillin/Oxacillin||0
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| |-
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| | ||Cloxacillin/Diclox.||0
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| |-
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| | Amino-Penicillins||AMP/Amox||0
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| |-
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| | ||Amox/Clav||0
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| |-
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| | ||AMP-Sulb||0
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| |-
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| | Anti-Pseudomonal Penicillins||Ticarcillin||0
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| |-
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| | ||Ticar-Clav||0
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| |-
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| | ||Pip-Taxo||0
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| |-
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| | [[Carbapenems]]||Piperacillin||0
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| |-
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| | ||Doripenem||0
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| |-
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| | ||Ertapenem||0
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| |-
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| | ||Imipenem||0
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| |-
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| | ||Meropenem||0
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| |-
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| | ||[[Aztreonam]]||0
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| |-
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| | [[Fluroquinolones]]||[[Ciprofloxacin]]||0
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| |-
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| | ||Ofloxacin||0
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| |-
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| | ||Pefloxacin||0
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| |-
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| | ||[[Levofloxacin]]||0
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| |-
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| | ||Moxifloxacin||+/-
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| |-
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| | ||Gemifloxacin||+/-
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| |-
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| | ||Gatifloxacin||+/-
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| |-
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| | 1st G [[Cephalosporin]]||Cefazolin||0
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| |-
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| | 2nd G. [[Cephalosporin]]||[[Cefotetan]]||0
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| |-
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| | ||Cefoxitin||0
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| |-
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| | ||Cefuroxime||0
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| |-
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| | 3rd/4th G. [[Cephalosporin]]||[[CefoTAXime]]||0
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| |-
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| | ||Cefizoxime||0
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| |-
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| | ||[[CefTRIAXone]]||0
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| |-
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| | ||Ceftobiprole||+
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| |-
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| | ||Ceftaroline||+
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| |-
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| | ||[[CefTAZidime]]||0
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| |-
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| | ||[[Cefepime]]||0
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| |-
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| | Oral 1st G. [[Cephalosporin]]||Cefadroxil||0
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| |-
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| | ||[[Cephalexin]]||0
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| |-
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| | Oral 2nd G. [[Cephalosporin]]||Cefaclor/Loracarbef||0
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| |-
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| | ||Cefproxil||0
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| |-
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| | ||Cefuroxime axetil||0
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| |-
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| | Oral 3rd G. [[Cephalosporin]]||Cefixime||0
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| |-
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| | ||Ceftibuten||0
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| |-
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| | ||Cefpodox/Cefdinir/Cefditoren||0
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| |-
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| | [[Aminoglycosides]]||[[Gentamicin]]||0
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| |-
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| | ||Tobramycin||0
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| |-
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| | ||[[Amikacin]]||0
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| |-
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| | ||Chloramphenicol||0
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| |-
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| | ||[[Clindamycin]]||0
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| |-
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| | [[Macrolides]]||Erythromycin||0
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| |-
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| | ||[[Azithromycin]]||0
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| |-
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| | ||Clarithromycin||0
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| |-
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| | Ketolide||Telithromycin||0
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| |-
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| | Tetracyclines||[[Doxycycline]]||+/-
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| |-
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| | ||Minocycline||+/-
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| |-
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| | Glycylcycline||Tigecycline||+
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| |-
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| | Glyco/Lipoclycopeptides||[[Vancomycin]]||+
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| |-
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| | ||Teicoplanin||+
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| |-
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| | ||Telavancin||+
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| |-
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| | ||Fusidic Acid||+
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| |-
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| | ||Trimethoprim||+/-
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| |-
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| | ||[[TMP-SMX]]||+
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| |-
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| | Urinary Agents||[[Nitrofurantoin]]||+
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| |-
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| | ||Fosfomycin||
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| |-
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| | Other||[[Rifampin]]||+
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| |-
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| | ||[[Metronidazole]]||0
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| |-
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| | ||Quinupristin dalfoppristin||+
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| |-
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| | ||Linezolid||+
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| |-
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| | ||[[Daptomycin]]||+
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| |-
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| | ||Colistimethate||0
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| |}
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| ===Key===
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| {{Template:Antibacterial Spectra Key}}
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| ==Table Overview== | | ==Table Overview== |
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| *[[Staph. aureus]] | | *[[Staph. aureus]] |
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| ==Source== | | ==References== |
| *EBmedicine.net
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| ==References== | | ==References== |
| <references/> | | <references/> |
| [[Category:ID]] | | [[Category:ID]] |
