sábado, 19 de marzo de 2011

Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive Summary

New Clinical Guidelines for MRSA Treatment
Categories: Healthcare-associated infections, MRSA

March 18th, 2011 1:43 pm ET -

Catherine Liu, MD
Author – Dr. Catherine Liu
Assistant Clinical Professor, Division of Infectious Diseases, University of California

Methicillin-resistant Staphylococcus aureus (MRSA) – both healthcare- and community-associated – has become an enormous public health problem. MRSA is responsible for about 60 percent of skin and soft tissue infections seen in emergency rooms, and invasive MRSA kills about 18,000 people annually. Clinicians often struggle with how best to treat MRSA, resulting in wide variations in approaches to therapy. The growing clinical impact of MRSA, particularly community-acquired infections, prompted the Infectious Diseases Society of America to develop its first treatment guidelines for MRSA. Charged with reviewing the evidence and developing the guidelines, my coauthors and I aimed to create a framework to help clinicians evaluate and treat uncomplicated and invasive MRSA infections. As with all IDSA guidelines, they are voluntary and are not meant to replace clinical judgment, but rather synthesize the available evidence and support the decision-making process, which must be individualized for each patient.

The guidelines address 11 topics commonly encountered by adult and pediatric clinicians. They provide guidance in the management of: skin and soft tissue infections including recurrent infections; use of intravenous vancomycin; and invasive infections, such as pneumonia, and infections in the bones, joints, blood or heart.

In the midst of our battle against drug resistance, IDSA hopes the guidelines highlight the importance of the judicious use of antibiotics. For instance, the bulk of the evidence so far suggests incision and drainage may be adequate for the treatment of simple abscesses or boils. We’re eagerly awaiting the results of two large, NIH-sponsored, randomized trials to further clarify the role of antibiotics in this setting.

The guidelines also call for better drugs to treat MRSA. Although a number of new drugs have been developed and FDA-approved, we have yet to discover the golden bullet.

Of course, additional research is necessary on MRSA and as with all IDSA guidelines, these recommendations will evolve as new information and antibiotics become available.

See the full-text “Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children,” [Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children] or pick up the Feb. 1 issue of Clinical Infectious Diseases.



Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive Summary


Catherine Liu1, Arnold Bayer3,5, Sara E. Cosgrove6, Robert S. Daum7, Scott K. Fridkin8, Rachel J. Gorwitz9, Sheldon L. Kaplan10, Adolf W. Karchmer11, Donald P. Levine12, Barbara E. Murray14, Michael J. Rybak12,13, David A. Talan4,5, and Henry F. Chambers1,2


+ Author Affiliations
1Department of Medicine, Division of Infectious Diseases, University of California-San Francisco, San Francisco, California
2Division of Infectious Diseases, San Francisco General Hospital, San Francisco, CA
3Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA
4Divisions of Emergency Medicine and Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA
5Department of Medicine, David Geffen School of Medicine at University of California- Los Angeles
6Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland
7Department of Pediatrics, Section of Infectious Diseases, University of Chicago, Chicago, Illinois
8
9Division of Healthcare Quality Promotion, Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
10Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
11Division of Infectious Diseases, Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, Massachusetts
12 Department of Medicine, Division of Infectious Diseases, Wayne State University, Detroit Receiving Hospital and University Health Center, Detroit, Michigan
13Deparment of Pharmacy Practice, Wayne State University, Detroit Michigan
14Division of Infectious Diseases and Center for the Study of Emerging and Re-emerging Pathogens, University of Texas Medical School, Houston, Texas



Correspondence: Catherine Liu, MD, Dept of Medicine, Div of Infectious Diseases, University of California–San Francisco, San Francisco, California, 94102 (catherine.liu@ucsf.edu).


Abstract

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.


EXECUTIVE SUMMARY

MRSA is a significant cause of both health care–associated and community-associated infections. This document constitutes the first guidelines of the IDSA on the treatment of MRSA infections. The primary objective of these guidelines is to provide recommendations on the management of some of the most common clinical syndromes encountered by adult and pediatric clinicians who care for patients with MRSA infections. The guidelines address issues related to the use of vancomycin therapy in the treatment of MRSA infections, including dosing and monitoring, current limitations of susceptibility testing, and the use of alternate therapies for those patients with vancomycin treatment failure and infection due to strains with reduced susceptibility to vancomycin. The guidelines do not discuss active surveillance testing or other MRSA infection–prevention strategies in health care settings, which are addressed in previously published guidelines [1, 2]. Each section of the guidelines begins with a specific clinical question and is followed by numbered recommendations and a summary of the most-relevant evidence in support of the recommendations. Areas of controversy in which data are limited or conflicting and where additional research is needed are indicated throughout the document and are highlighted in the Research Gaps section. The key recommendations are summarized below in the Executive Summary; each topic is discussed in greater detail within the main body of the guidelines.

Please note that specific recommendations on vancomycin dosing and monitoring are not discussed in the sections for each clinical syndrome but are collectively addressed in detail in Section VIII.

I. What is the management of skin and soft-tissue infections (SSTIs) in the era of community-associated MRSA (CA-MRSA)?

full-text (large):
Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive Summary

No hay comentarios: