Community Associated MRSA

ADULT

• For a cutaneous abscess, incision and drainage is the primary treatment
• Antibiotic therapy is recommended for abscesses associated with the following conditions: severe or extensive disease (eg, involving multiple sites of infection) or rapid progression in presence of associated cellulitis, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, extremes of age, abscess in area difficult to drain (eg, face, hand, and genitalia), associated septic phlebitis, lack of response to I &D alone

outpatients with purulent cellulitis

• eg, cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess
• empirical therapy for CA-MRSA is recommended pending culture results.
• Empirical therapy for infection due to b-hemolytic streptococci is likely unnecessary
• Five to 10 days of therapy is recommended

outpatients with nonpurulent cellulitis

• eg, cellulitis with no purulent drainage or exudate and no associated abscess)
• empirical therapy for infection due to b-hemolytic streptococci is recommended (A-II). 
• The role of CA-MRSA is unknown.
• Empirical coverage for CA-MRSA is recommended in patients who do not respond to b-lactam therapy and may be considered in those with systemic toxicity.
• Five to 10 days of therapy is recommended
• empirical coverage of CA-MRSA
• clindamycin
• TMP-SMX
• a tetracycline (doxycycline or minocycline) and linezolid
• If coverage for both b-hemolytic streptococci and CA-MRSA
• clindamycin alone
• TMP-SMX or a tetracycline in combination with a b-lactam (eg, amoxicillin)
• linezolid alone
• use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended

hospitalized patients with complicated SSTI

• in addition to surgical debridement and broad-spectrum antibiotics, empirical therapy for MRSA should be considered pending culture data
• Options include the following:
• IV vancomycin
• Linezolid 600 mg PO/IV twice daily
• clindamycin 600 mg IV/PO three times a day
• b-lactam antibiotic (eg, cefazolin) may be considered in hospitalized patients with nonpurulent cellulitis with modification to MRSA-active therapy if there is no clinical response
• Seven to 14 days of therapy is recommended

Pediatric

• Tetracyclines should not be used in children ,8 years of age
• If the patient is stable without ongoing bacteremia or intravascular infection, empirical therapy with
• clindamycin 10–13 mg/kg/dose IV every 6–8 h
• In hospitalized children with cSSTI, vancomycin is recommended

Antibiotics Considerations

• Oral AB may be used as empirical therapy for CAMRSA include TMP-SMX, doxycycline (or minocycline), clindamycin,
• need to include coverage against b-hemolytic streptococci in addition to CA-MRSA is controversial and may vary
• TMP-SMX, doxycycline, and minocycline have good in vitro activity against CA-MRSA, their activity against b- hemolytic streptococci is not well-defined
• Clindamycin is active against b- hemolytic streptococci, although MRSA susceptibility rates may vary by region

References:

1. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children. Clinical Infectious Diseases 2011;1–38