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IDSA guidelines address management of MRSA infections

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In 2011, the Infectious Diseases Society of America published its first clinical practice guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.

The guidelines address a variety of skin and soft-tissue infections caused by MRSA.

Regarding the management of skin and soft tissue infections, IDSA recommends:

• Incision and drainage is the primary treatment for cutaneous abscesses, but for abscesses and boils, additional data must be collected to define the role of antibiotics.
• Antibiotic therapy is only recommended for severe or extensive disease, rapid progression in the presence of associated cellulitis, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, extremes of age, abscess in an area difficult to drain (eg, face, hand and genitalia), associated septic phlebitis, and lack of response to incision and drainage alone.
• Empirical therapy for community-associated MRSA is recommended pending culture results among outpatients with purulent cellulitis — beta-hemolytic streptococci treatment is likely unnecessary.
• Outpatients with nonpurulent cellulitis should be given empirical treatment with a beta-lactam antibiotic for beta-hemolytic streptococci.

Regarding the management of recurrent skin and soft-tissue infections, IDSA recommends:

• Patients should be educated on proper wound care and personal and environmental hygiene.
• Decolonization strategies may include nasal decolonization and/or topical body decolonization regimens. Further research must be undertaken to gauge best practices for recurrent infection prevention.

“The management of all MRSA infections should include identification, elimination and/or debridement of the primary source and other sites of infection when possible,” the guideline panel members wrote. “In patients with MRSA bacteremia, follow-up blood cultures 2 to 4 days after initial positive cultures and as needed thereafter are recommended to document clearance of bacteremia.”

For additional information:

http://www.healio.com/infectious-disease/mrsa/news/online/%7B0e6863a5-0af3-4379-8862-a61609679c7a%7D/idsa-releases-guidelines-for-mrsa

http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full#ref-1