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
8Division of Healthcare Quality Promotion, Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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.
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
Protect Yourself from MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to treatment with certain group of antibiotics called beta-lactams, including methicillin, oxacillin, penicillin, and amoxicillin.
In healthcare settings, MRSA infections occur most frequently among patients who undergo invasive medical procedures (such as surgery), have invasive devices (like catheters or ventilators), and who have weakened immune systems. MRSA in healthcare settings commonly causes serious and potentially life threatening infections, such as bloodstream infections, surgical site infections, or pneumonia.
How MRSA Spreads in Healthcare Settings
MRSA is mainly spread to other patients through human hands, especially healthcare personnel hands. Hands may become contaminated with MRSA bacteria following contact with MRSA-infected or colonized patients. If appropriate hand hygiene, such as washing with soap and water or using an alcohol-based hand rub, is not performed, the bacteria can be spread when the healthcare provider touches other patients.
How can I help protect myself or loved one in a healthcare facility?
•Since you are part of your healthcare team, do not be afraid to ask doctors or nurses to clean their hands before treating you. This includes washing their hands with soap and water or using an alcohol-based hand rub.
•Intravenous catheters or drainage tubes may serve as entry points for infection. Ask your doctor how long you will have this device and when they can be removed safely.
•Always ask visitors to clean their hands. If possible, ask your friends and relatives not to visit if they feel ill.
•When you go home, if you have wounds or a device such as a catheter or dialysis port make sure you know how to take care of them.
•After leaving a healthcare facility or after having a medical procedure done, pay attention to symptoms that may indicate an infection. These may include: unexpected pain, chills, fever, drainage, or increased inflammation (redness) around a surgical wound. Contact your doctor immediately if any of these occur.
What do to if you have an MRSA infection
To prevent another MRSA infection and to prevent spreading MRSA to others once you leave a healthcare facility, do the following:
•Clean your hands often, especially before and after changing your wound dressing or bandage.
•Tell people who live with you to clean their hands often as well.
•Keep any wounds clean and change bandages as instructed until healed.
•Keep taking any antibiotics prescribed by your doctor. Don't take half-doses or stop before you complete your prescribed course.
•Avoid sharing personal items such as towels or razors.
•Wash and dry your clothes and bed linens in the warmest temperatures recommended on the labels.
•Tell your healthcare providers that you have MRSA. This includes home health nurses and aides, therapists, and personnel in doctors' offices.
•Ask your doctor for any additional instructions.
What are some of the things that hospitals are doing to prevent MRSA infections?
To prevent MRSA infections, doctors, nurses and other healthcare providers:
•Clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient.
•Carefully clean hospital rooms and medical equipment.
•Use Contact Precautions when caring for patients with MRSA. Contact Precautions mean:
◦Whenever possible, patients with MRSA will have a single room or will share a room with only someone else who also has MRSA.
◦Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MRSA.
◦Visitors may also be asked to wear a gown and gloves.
◦When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands.
◦Patients on Contact Precautions are asked to stay in their hospital rooms as much as possible.
•May test some patients to see if they carry MRSA and should be cared for using Contact Precautions. This test involves rubbing a cotton-tipped swab in the patient's nostrils.
Fewer MRSA infections in healthcare
In 2010, encouraging results from a CDC study published in the Journal of the American Medical Association [Health Care–Associated Invasive MRSA Infections, 2005-2008, August 11, 2010, Kallen et al. 304 (6): 641 — JAMA] showed that invasive (life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 28% from 2005 through 2008. Decreases in infection rates were even bigger for patients with bloodstream infections. In addition, the study showed a 17% drop in invasive MRSA infections that were diagnosed before hospital admissions (community onset) in people with recent exposures to healthcare settings.
This study complements data from CDC's healthcare-associated infection tracking system, National Healthcare Safety Network (NHSN)[CDC - NHSN], which found rates of MRSA bloodstream infections occurring in hospitalized patients fell nearly 50% from 1997 to 2007.
Taken together and with other reports such as the March 2011 CDC Vital Signs [CDC Vital Signs - Making Health Care Safer] article, these studies provide evidence that rates of invasive MRSA infections in the United States are falling. While MRSA remains an important public health problem and more remains to be done to further decrease risks of developing these infections, this decrease in healthcare-associated MRSA infections is encouraging.
More Information
▲ Resources for patients:
•CDC's MRSA website ► CDC - Methicillin-resistant Staphylococcus Aureus (MRSA) Infections
•FAQ's for patients [PDF - 220KB] Resources for healthcare providers:
http://www.shea-online.org/Assets/files/patient%20guides/NNL_MRSA.pdf
▲▲ Resources for healthcare providers:
•CDC Guidelines: Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006 [PDF - 233 KB] available for download: http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
•Compendium of Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals: SHEA > Guidelines & Resources > Compendium of Strategies to Prevent HAIs
•Clinical Practice Guidelines by the Infectious Disease 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
▲▲▲ Recent research on MRSA prevention
•New England Journal of Medicine: Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care: Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care — NEJM
•New England Journal of Medicine: Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections: Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections — NEJM
FULL-TEXT:
CDC Features - Protect Yourself from MRSA
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