Key Points ÎMethicillin-resistant (MRSA) is a significant
cause of both healthcare (HA-MRSA) and community-associated (CA-MRSA) infections with an enormous clinical and economic impact.
ÎMRSA causes a wide spectrum of illness including skin and soft tissue infections (SSTIs), bacteremia and endocarditis, pneumonia, bone and joint infections, central nervous system disease, toxic shock and sepsis syndromes.
ÎThe management of all MRSA infections should include identification, elimination and/or debridement of the primary source and other sites of infection when possible (eg, drainage of abscesses, removal of central venous catheters, debridement of osteomyelitis, etc.).
ÎIn patients with MRSA bacteremia, follow-up blood cultures 2-4 days after initial positive cultures and as needed thereafter are recommended to document clearance of bacteremia.
ÎTo optimize serum trough concentrations in adult patients, vancomycin should be dosed according to actual body weight (15-20 mg/kg/dose every 8-12 hours), not to exceed 2 grams per dose. Trough monitoring is recommended to achieve target concentrations of 15-20 mcg/mL in patients with serious MRSA infections and to ensure target
Selecting a Treatment Regimen
Table 1. Recommendations for the Treatment of MRSA Manifestation
Management/ Surgery
Minor skin infections (impetigo, secondarily infected skin lesions such as eczema, ulcers or lacerations)
Abscesses, furuncles, carbuncles
Incision and drainage (I & D)
NOTE: The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is NOT recommended (A-III).
Duration of Therapy Skin and Soft Tissue Infections (SSTI)* - Outpatients Agent Treatments Antibiotics Adult Dose
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