Infectious Disease Book

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Methicillin Resistant Staphylococcus AureusAka: Methicillin Resistant Staph Aureus, MRSA

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  1. See Also
    1. Staphylococcus aureus
  2. Epidemiology
    1. High risk for elderly in institutional settings
    2. MRSA colonized patients
      1. Higher risk of infection
      2. Higher risk of death due to Antibiotic Resistance
    3. Community acquired MRSA
      1. Unique from hospital acquired cases
      2. Higher risk groups
        1. Athletes (contact sports with frequent abrasions)
        2. Crowded ling conditions
        3. Military recruits
        4. Pacific Island residents
        5. Natives of Alaska
        6. Native Americans
        7. Prison inmates
        8. Men who have sex with men
        9. Intravenous drug use
        10. Close contact with MRSA colonized person
      3. Accounts for 60% of staph infections in some states
        1. Alaska
        2. California
        3. Georgia
        4. Texas
      4. Recent outbreaks in midwest community settings
        1. Minnesota
        2. North Dakota
        3. (1999) MMWR Morb Mortal Wkly Rep 48:707
  3. Evaluation
    1. Base treatment on culture and sensitivity
  4. Characteristics
    1. Typically involves skin and soft tissue infections
      1. Now MRSA appears to be most common organism
    2. Consider as superinfection following Influenza
  5. Management: Outpatient
    1. Consider not using antibiotics
      1. Abscess <5 cm
    2. Avoid beta lactam antibiotics (not effective)
    3. Dicloxacillin and Cephalexin are not effective for MRSA
    4. Avoid Fluoroquinolones due to resistance
    5. Oral antibiotics with efficacy against MRSA
      1. Trimethoprim Sulfamethoxazole (Bactrim)
      2. Minocycline or Doxycycline
      3. Clindamycin (Risk of induced resistance)
      4. Rifampin (risk of induced resistance)
        1. Use in combination with above agents
      5. Linezolid (very expensive)
  6. Management: Inpatient
    1. Vancomycin
      1. Try other antibiotics above prior to Vancomycin
      2. Decreases Vancomycin resistance risk
    2. New agents with MRSA activity (only for severe cases)
      1. Synercid (Quinupristin-Dalfopristin)
      2. Cyclic Lipopeptide: Cubicin (Daptomycin)
        1. Complicated skin and soft tissue infections
        2. Do not use for Pneumonia
      3. Zyvox (Linezolid)
        1. Complicated skin and soft tissue infections
        2. Complicated Pneumonia
      4. Tigecycline
    3. First-line antibiotics
      1. Vancomycin is only first-line agent in many cases
      2. Linezolid is also first-line for MRSA Pneumonia
    4. Alternative antibiotics
      1. Linezolid
      2. Daptomycin (do not use in Pneumonia)
  7. Prevention
    1. MRSA colonization in physicians is common
    2. Control of contagious spread
      1. Careful and frequent hand washing or Alcohol gels
      2. Proper handling of bodily secretions
      3. Isolate infected patients (cover wounds)
      4. Remove colonized catheters
      5. Clean under Fingernails and keep nails short
      6. Do not share towels, razors, linens
    3. Identify source case of infection
      1. Swab nasopharynx of patients and staff near outbreak
      2. Consider treating MRSA carriers
        1. Bactroban applied bid to nares and wounds
        2. Chlorhexidine (Hibiclens) baths
  8. References
    1. (2005) Lexi-comp Drug Database
    2. Bamberger (2005) Am Fam Physician 72:2474
    3. Michel (1997) Lancet 349:1901
    4. Kauffman (1993) Am J Med 94:371

MENTAL RETARDATION, X-LINKED, SOUTH AFRICAN TYPE (C1846130)

ConceptsGene or Genome (T028)
EnglishMRSA
SourcesMTH, OMIM
Derived from the NIH UMLS (Unified Medical Language System)



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