Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children

Abstract

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

“…The most recent guidelines on the treatment of MRSA published by the Infectious Diseases Society of America (IDSA) in 2011 give no information on the importance of an MIC within the susceptible range for clinical decision-making [10,11]. However, these were written in 2010 and evidence has continued to emerge since their inception and subsequent publication.…”

Treatment of severe MRSA infections: current practice and further development

“…Thirdly, combination therapy may be used. Combinations of two primary active agents (such as vancomycin plus linezolid) or the addition of gentamicin or rifampin to either vancomycin or daptomycin did not prove to be synergistic [6]. Rifampin, owing to its activity in biofilms, may retain a role as a secondary agent in prosthetic valve endocarditis and bone/joint infections with or without infected implants, but should only be started after clearance of bacteremia.…”

“…However, these higher doses are associated with increased incidence of nephrotoxicity. Continuous infusion has been associated with lower rates of nephrotoxicity (nephrotoxicity threshold around 28 μg/mL), higher steady state concentration, faster achievement of target concentrations, less variability in serum concentrations, and simpler AUC assessment, compared with intermittent dosing [5]; however, there is no evidence of higher effectiveness of the continuous regimen [6].…”

46-Year-Old Man With Fevers, Chills, and Pancytopenia

“…1 Our patient has purulent cellulitis and therefore should be treated for community-acquired MRSA. Trimethoprim-sulfamethoxazole (Bactrim) has good coverage for community-acquired MRSA and would be recommended in this scenario.…”