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Evidence based approach to the treatment of community-associated methicillin-resistant Staphylococcus aureus.

Peppard WJ, Daniels A, Fehrenbacher L, Winner J - Infect Drug Resist (2009)

Bottom Line: However, resistance, susceptibilities, patient-specific circumstances, and adverse effects can impact a healthcare professional's choice of antibiotics.In patients with complicated infections requiring hospitalization or parenteral treatment, vancomycin remains the drug of choice, even though increased resistance and decreased efficacy have crept into clinical practice.Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are alternative intravenous agents for the treatment of CA-MRSA.

View Article: PubMed Central - PubMed

Affiliation: Froedtert Hospital Milwaukee, Wisconsin, USA;

ABSTRACT
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased dramatically over the last two decades. The types of infections can range from complicated skin and skin structure infections (cSSSI) to pneumonia and endocarditis. Oral antimicrobial therapy, such as trimethoprim-sulfamethoxazole, clindamycin, long-acting tetracyclines, or linezolid may provide enhanced benefit to those with uncomplicated cutaneous lesions when used in conjunction with incision and drainage in an outpatient setting. However, resistance, susceptibilities, patient-specific circumstances, and adverse effects can impact a healthcare professional's choice of antibiotics. In patients with complicated infections requiring hospitalization or parenteral treatment, vancomycin remains the drug of choice, even though increased resistance and decreased efficacy have crept into clinical practice. Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are alternative intravenous agents for the treatment of CA-MRSA. Investigational agents such as dalbavancin, telavancin, oritivancin, iclaprim, ceftobiprole, ceftaroline, and others may expand our therapeutic armamentarium for the treatment of infections caused by CA-MRSA in the future.

No MeSH data available.


Related in: MedlinePlus

Outpatient management of suspected community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections. Adapted from Aurora Health Care MRSA Clinical Guidelines 2008. Kathryn Leonhardt, MD, MPH, Editor.Abbreviations: I&D, incision and drainage; MRSA, methicillin-resistant S. aureus; CA-MRSA, community-associated MRSA.
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f1-idr-2-027: Outpatient management of suspected community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections. Adapted from Aurora Health Care MRSA Clinical Guidelines 2008. Kathryn Leonhardt, MD, MPH, Editor.Abbreviations: I&D, incision and drainage; MRSA, methicillin-resistant S. aureus; CA-MRSA, community-associated MRSA.

Mentions: The treatment approach for CA-MRSA infections is variable based upon severity and site of infection. As discussed previously in this article, the majority of CA-MRSA infections are cutaneous infections and many may be managed on an outpatient basis. While the general consensus is that minor infections can be managed by incision and drainage (I&D) alone, many practitioners are opting to also treat with oral antimicrobials when MRSA diagnosis is confirmed by culture. A study by Moran and colleagues evaluated CA-MRSA patients presenting to the Emergency Department.83 Approximately 20% of patients underwent I&D alone, 10% were treated with antibiotics alone, and 66% received both I&D and antibiotic therapy. The 2005 Infectious Diseases Society of America Practice Guideline for the Diagnosis and Management of Skin and Soft-Tissue Infections recommends that if the infection involves inflammation of the surrounding tissue or has manifested in systemic symptoms, I&D with concomitant antimicrobial therapy.84 Figure 1 summarizes a possible treatment approach for the outpatient management of suspected CA-MRSA SSSI.


Evidence based approach to the treatment of community-associated methicillin-resistant Staphylococcus aureus.

Peppard WJ, Daniels A, Fehrenbacher L, Winner J - Infect Drug Resist (2009)

Outpatient management of suspected community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections. Adapted from Aurora Health Care MRSA Clinical Guidelines 2008. Kathryn Leonhardt, MD, MPH, Editor.Abbreviations: I&D, incision and drainage; MRSA, methicillin-resistant S. aureus; CA-MRSA, community-associated MRSA.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108727&req=5

f1-idr-2-027: Outpatient management of suspected community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections. Adapted from Aurora Health Care MRSA Clinical Guidelines 2008. Kathryn Leonhardt, MD, MPH, Editor.Abbreviations: I&D, incision and drainage; MRSA, methicillin-resistant S. aureus; CA-MRSA, community-associated MRSA.
Mentions: The treatment approach for CA-MRSA infections is variable based upon severity and site of infection. As discussed previously in this article, the majority of CA-MRSA infections are cutaneous infections and many may be managed on an outpatient basis. While the general consensus is that minor infections can be managed by incision and drainage (I&D) alone, many practitioners are opting to also treat with oral antimicrobials when MRSA diagnosis is confirmed by culture. A study by Moran and colleagues evaluated CA-MRSA patients presenting to the Emergency Department.83 Approximately 20% of patients underwent I&D alone, 10% were treated with antibiotics alone, and 66% received both I&D and antibiotic therapy. The 2005 Infectious Diseases Society of America Practice Guideline for the Diagnosis and Management of Skin and Soft-Tissue Infections recommends that if the infection involves inflammation of the surrounding tissue or has manifested in systemic symptoms, I&D with concomitant antimicrobial therapy.84 Figure 1 summarizes a possible treatment approach for the outpatient management of suspected CA-MRSA SSSI.

Bottom Line: However, resistance, susceptibilities, patient-specific circumstances, and adverse effects can impact a healthcare professional's choice of antibiotics.In patients with complicated infections requiring hospitalization or parenteral treatment, vancomycin remains the drug of choice, even though increased resistance and decreased efficacy have crept into clinical practice.Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are alternative intravenous agents for the treatment of CA-MRSA.

View Article: PubMed Central - PubMed

Affiliation: Froedtert Hospital Milwaukee, Wisconsin, USA;

ABSTRACT
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased dramatically over the last two decades. The types of infections can range from complicated skin and skin structure infections (cSSSI) to pneumonia and endocarditis. Oral antimicrobial therapy, such as trimethoprim-sulfamethoxazole, clindamycin, long-acting tetracyclines, or linezolid may provide enhanced benefit to those with uncomplicated cutaneous lesions when used in conjunction with incision and drainage in an outpatient setting. However, resistance, susceptibilities, patient-specific circumstances, and adverse effects can impact a healthcare professional's choice of antibiotics. In patients with complicated infections requiring hospitalization or parenteral treatment, vancomycin remains the drug of choice, even though increased resistance and decreased efficacy have crept into clinical practice. Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are alternative intravenous agents for the treatment of CA-MRSA. Investigational agents such as dalbavancin, telavancin, oritivancin, iclaprim, ceftobiprole, ceftaroline, and others may expand our therapeutic armamentarium for the treatment of infections caused by CA-MRSA in the future.

No MeSH data available.


Related in: MedlinePlus