New guidelines set out MRSA treatments

The Infectious Diseases Society of America released its first set of guidelines on the treatment of methicillin-resistant Staphylococcus aureus (MRSA) last week.

The guidelines were developed by an expert panel of infectious disease specialists and cover MRSA infections associated with health care facilities (HA-MRSA) as well as those acquired in the community (CA-MRSA). The guidelines note that the "so-called CA-MRSA isolates" are genetically distinct from HA-MRSA and susceptible to many non-ß-lactam antibiotics. Recommendations are provided on the appropriate treatment—both antibiotic and non-drug—of skin and soft-tissue infections, from simple abscesses seen in the outpatient setting to complicated infections in hospitalized patients.

The guidelines also discuss management of recurrent MRSA skin and soft-tissue infections, recommending education on personal hygiene for all patients, with decolonization and oral therapy reserved for patients in which other measures are unsuccessful. Appropriate antibiotic and other therapy for MRSA bacteremia and infective endocarditis, MRSA pneumonia, and MRSA infections in bones, joints and the central nervous system are also covered in the guidelines, which will appear in the Feb. 1 issue of Clinical Infectious Diseases. Local variations in epidemiology should be considered by physicians implementing the guidelines, the authors noted.

The guidelines provide advice on vancomycin therapy, including the limitations of vancomycin susceptibility testing. If testing indicates a vancomycin minimum inhibitory concentration (MIC) of less than or equal to 2 µg/mL, the patient's clinical response should determine use of vancomycin. If the MIC is greater than 2 µg/mL, an alternative drug should be used. The guidelines recommend dosing and monitoring vancomycin according to a previous consensus statement from the IDSA and other groups. The new guidelines have been endorsed by the Pediatric Infectious Diseases Society, the American College of Emergency Physicians and the American Academy of Pediatrics.