Management of Methicillin-Resistant Staphylococcus aureus Infections

Target Population: Infectious diseases specialists

Type: Consensus statement

Key Points: These guidelines are the first from the Infectious Diseases Society of America (IDSA) to address methicillin-resistant Staphylococcus aureus (MRSA) infections. The recommendations are preceded by an executive summary and a literature review that contains a description of available antibiotics.

Comprehensive guidance is provided for managing the most common clinical syndromes associated with MRSA infection. Each section has an evidence review detailing the rationale behind the recommendations, as well as information on the management of adult and pediatric patients. Table 3 summarizes the recommendations for each clinical syndrome. A lengthy section is devoted to the management of persistent bacteremia in patients with vancomycin treatment failure.

Particularly useful recommendations include the following:

• For simple MRSA skin abscesses, incision and drainage alone is probably adequate.

• Outpatients with purulent cellulitis should receive empirical therapy for community-associated MRSA pending culture results; those with nonpurulent cellulitis should receive empirical therapy for β-hemolytic streptococci.

• If, despite optimized wound care and hygiene, a patient develops multiple recurrent skin or soft-tissue infections, or transmission is ongoing among household members or other close contacts, decolonization strategies may be considered.

• In adults, vancomycin dosing should be guided by trough concentrations of the drug; a loading dose of 25 to 30 mg/kg may be considered for patients who are seriously ill. (Data for children are limited; however, a target trough concentration of 15–20 µg/mL should be considered for pediatric patients with serious infections.)

• For patients whose isolates have a vancomycin minimum inhibitory concentration >2 µg/mL, an alternative drug should be used.

• For patients with osteomyelitis, device-related osteoarticular infections, or prosthetic valve endocarditis, rifampin can be used in conjunction with other antibiotics.