Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community

Abstract

These guidelines have been developed by a Working Party convened on behalf of the British Society for Antimicrobial Chemotherapy. Their aim is to provide general practitioners and other community- and hospital-based healthcare professionals with pragmatic advice about when to suspect MRSA infection in the community, when and what cultures should be performed and what should be the management options, including the need for hospitalization.

Skin and Soft Tissue Infections

“…They include rifampicin and sodium fusidate, doxycycline; rifampicin and trimethoprim or linezolid, rifampicin+trimethoprim; or linezolid. 35 Glycopeptides or daptomycin may be used in moderately severe infections especially in the outpatient settings.Linezolid is another alternative in this context. 36 …”

MRSA as a cause of lung infection including airway infection, community-acquired pneumonia and hospital-acquired pneumonia

“…There may be a unilateral consolidation or bilateral infiltrates, especially in PVL producing CA-MRSA. Compared with HA-MRSA pneumonia these infiltrates are more likely to cavitate, which may be seen on serial CXR and best Reproduced from [17] with permission from the publisher. Reproduced from [17] with permission from the publisher.…”

“…As stated previously it is unlikely that PVL alone accounts for the increased invasiveness of CA-MRSA, instead a combination of virulence factors including protein A and the haemolysins a and c are likely to play a role in the invasiveness of CA-MRSA lung infections. The principle differences between CA-MRSA and HA-MRSA are summarised in table 1 [17]. The epidemiology and clinical burden of MRSA infections in Europe will be discussed later.…”

Did CA-MRSA Bacteremia Exist in Taiwanese Patients With End-Stage Renal Disease?

“…This fact contradicts the present definition for CA-MRSA, because MRSA detected in persons with healthcare-associated risk factors, such as dialysis, within 1 year before onset of MRSA infection is not considered to be community acquired. 2 One of the other criteria adopted by Lin and colleagues for identifying CA-MRSA and HA-MRSA was staphylococcal cassette chromosome (SCC) mec typing. They identified MRSA strains with SCCmec types IV or V as community acquired and MRSA strains with SCCmec types II or III as healthcare acquired.…”