Methicillin-Resistant Staphylococcus Aureus (MRSA)
Community-associated ...

Methicillin-Resistant Staphylococcus Aureus (MRSA)

Community-associated MRSA: No healthcare exposure

 • Skin and soft tissue infections in young healthy individuals. Usually sensitive to non-β -lactam abx 

 • If shock, consider toxin-producer (PVL MRSA causes necrotizing PNA, severe SSTI). Tx: Add Clinda/Linezolid

Hospital-acquired MRSA

 • Risk: abx use, prolonged hospitalization/ICU, HD, MRSA colonization, tubes/hardware (biofilms→ET tubes, urinary/endovascular catheters)

 • Bacteremia: TTE +/- targeted imaging to eval metastatic infxn

 • Nasal Swab: High NPV for pneumonia (up to 96.5%), not as well studied for other MRSA infections. Therefore more useful if (-) swab-> consider discontinuing MRSA coverage in pneumonia

Treatment: Always check the Vanc MIC! (see Box above)

 • Serious infections (i.e., bacteremia): Vanc (w/ full loading dose) and ID c/s. If persistent bacteremia or MIC >2, consider Dapto (NOT in PNA [inactivated by surfactant] or meningitis [doesn’t cross BBB]), or add Ceftaroline

 • Mild infections (e.g., PNA, SSTI): Bactrim, Doxycycline, Clindamycin (less sensitive), Linezolid

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