Health Care Providers
Communicable Diseases, Epidemiology and Immunization
October 19, 2007
Health Update: Methicillin-Resistant Staph aureus (MRSA) Infection
Background: A recent study of invasive MRSA infections in 9 locations in the US (none in Washington) during 2004-05 has led to an increased awareness of this infection.1 In this study, about 85% of all invasive MRSA infections were associated with healthcare, and of those, about two-thirds occurred outside of the hospital, while about one third occurred during hospitalization. About 14% of all the infections occurred in persons without obvious exposures to healthcare (Community-associated
MRSA
,
CA
-MRSA) and the rate of CA-MRSA varied among the study communities from 1.6-29.7/100,000. The following guidance supplements that issued by Public Health in 2003 and 2004.
Action requested:
- Consider MRSA infection in patients with community-acquired skin and soft tissue infections and in patients with invasive disease compatible with S. aureus infection (i.e., sepsis syndrome, pneumonia, pyomyositis, bone and joint infections).
- Obtain bacterial cultures and antimicrobial sensitivity testing
- Empiric treatment of suspected invasive or severe S. aureus infections should include coverage for MRSA until results of culture and susceptibility testing are available
- For non-severe suspected MRSA in outpatients requiring antibiotic therapy consider empiric treatment active against MRSA infections, particularly in settings where MRSA is frequent
- Consider trimethoprim-sulfamethoxazole, doxycycline, or clindamycin for empiric outpatient treatment of skin and soft tissue infections
- Beta-lactams, fluoroquinolones and macrolides are not recommended for empiric treatment of MRSA infections
- Incision and drainage (I & D) of abscesses should be done whenever possible. For mild uncomplicated abscesses, local wound care including I & D without antibiotic use is a reasonable treatment option.
- See references below for important additional information on treatment, laboratory testing and infection control measures for CA-MRSA
Encourage influenza vaccination to decrease the risk for post-influenza MRSA pneumonia.
Report outbreaks of MRSA to Public Health at 206-296-4774.
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For information regarding treatment and management of CA-MRSA, including infection control measures to prevent transmission, see:
1Journal of the American Medical Association 2007;298(15):1763-1771
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