Methicillin-Resistant Staphylococcus Aureus (MRSA): Difference between revisions
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## [[Cephalexin]] + [[Bactrim DS]] | ## [[Cephalexin]] + [[Bactrim DS]] | ||
###Estimated 95-100% sensitivity of CA-MRSA | ###Estimated 95-100% sensitivity of CA-MRSA | ||
## Clindamycin | ## [[Clindamycin]] | ||
###Approximately 50% sensitivity to CA-MRSA | ###Approximately 50% sensitivity to CA-MRSA | ||
###Inducible resistance by erythromycin in laboratory, unclear significance | ###Inducible resistance by erythromycin in laboratory, unclear significance | ||
| Line 30: | Line 30: | ||
## [[Vancomycin]] IV if severe infection/sepsis | ## [[Vancomycin]] IV if severe infection/sepsis | ||
##Linezolid | ##Linezolid | ||
###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]] | ||
# [[I&D]] if [[abscess]] | # [[I&D]] if [[abscess]] | ||
##(antibiotics not needed if no e/o cellulitis) | ##(antibiotics not needed if no e/o [[cellulitis]]) | ||
==Antibiotic Sensitivities<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>== | ==Antibiotic Sensitivities<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>== | ||
Revision as of 06:43, 8 March 2014
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
- Cephalexin + 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
- Cephalexin + Bactrim DS
- I&D if abscess
- (antibiotics not needed if no e/o cellulitis)
Antibiotic Sensitivities[1]
| 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 |
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
Table Overview
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See Also
Source
- EBmedicine.net
References
- ↑ Sanford Guide to Antimicrobial Therapy 2010