Practice Guidelines: Managing MRSA Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health problem responsible for approximately 60% of skin infections seen in emergency departments. A growing number of cases affect children. Invasive MRSA infections, which are even more serious, result in an estimated 18,000 deaths a year. 

Earlier this year, the Infectious Diseases Society of America (IDSA) issued its first-ever clinical practice guidelines for treating MRSA infections in adults and children. The guidelines offer recommendations on appropriate antibiotic therapy as well as managing vancomycin treatment failures.

The guidelines also stress other treatments besides antibiotics. To prevent recurrent infections, for example, the IDSA suggests that patients be taught to cover draining wounds with clean, dry bandages; wash their hands frequently; and avoid reusing or sharing personal items. Oral antibiotics can be prescribed for active infections that persist despite improved wound hygiene.

Specific Guidelines

The IDSA recommendations include:

Skin and soft-tissue infections (SSTIs)

  • Incision and drainage for a cutaneous abscess
  • Antibiotic therapy for abscesses associated with extensive disease or difficult-to-drain areas, infections with rapid progression to cellulitis, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, and for patients who do not respond to incision and drainage
  • Oral antimicrobial therapy only for treating active infection 
  • When transmission to others is suspected, evaluation of contacts for possible infection
  • For purulent cellulitis, empirical antibiotic therapy for community-associated MRSA pending culture results; for nonpurulent cellulitis, empirical antibiotic therapy for infection due to β-hemolytic streptococci 
  • Cultures from abscesses and purulent SSTIs in patients treated with antibiotic therapy, those with severe local infection or signs of systemic illness, patients who do not respond to initial treatment, and those where a concern exists for a cluster or outbreak
  • For children: mupirocin 2% topical ointment in cases of minor skin infections; vancomycin in hospitalized children with SSTIs (tetracyclines should not be used in children younger than 8 years)

MRSA bacteremia and infective endocarditis

  • Vancomycin or daptomycin
  • Clinical assessment to identify the source and extent of the infection followed by elimination/debridement of other infection sites
  • For infective endocarditis, prosthetic valve: IV vancomycin plus rifampin for at least 6 weeks plus gentamicin for 2 weeks 
  • For children: IV vancomycin; if child is stable without ongoing bacteremia or intravascular infection, IV clindamycin with transition to oral therapy; Linezolid as an alternative.

MRSA pneumonia

  • For hospitalized patients with severe community-associated pneumonia: empirical antibiotic therapy pending sputum/blood culture results
  • For healthcare- or community-associated MRSA pneumonia: IV vancomycin, linezolid, or clindamycin (if the strain is susceptible) 
  • For children: IV vancomycin

MRSA bone and joint infections

  • For osteomyelitis: surgical debridement and drainage of associated soft-tissue abscesses with parenteral, oral, or initial parenteral therapy followed by oral therapy
  • For septic arthritis: drainage or debridement of the joint space and a 3- to 4-week course of antibiotic therapy

MRSA infections of the central nervous system 

  • For meningitis: IV vancomycin for 2 weeks 
  • In brain abscess, subdural empyema, and spinal epidural abscess: neurosurgical evaluation for incision and drainage and IV vancomycin for 4 to 6 weeks

Septic thrombosis of cavernous or dural venous sinus

  • Surgical evaluation for incision and drainage of contiguous sites of infection or abscess
  • IV vancomycin for 4 to 6 weeks
  • For children: IV vancomycin

Mosby’s Nursing Suite brings you these Practice Guidelines because we are committed to helping nurses provide exceptional patient care. And now, we’re honoring nurses who do just that with our ‘Superheroes of Nursing‘ contest. This month, we are looking for a super nurse who excels at providing the best patient care possible. Click here to learn more about the contest. 

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