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Gram Positive Bacteria
1] MSSA (methicillin susceptible strains)
2] MRSA (methicillin resistant Staph aureus)
(facultative anaerobic Gram-positive coccal bacterium; catalase-positive)
-Usually found in normal skin flora, anterior nares of the nasal passages, and respiratory tract.
-Frequent contributor to skin and respiratory infections.
-Antibiotic-resistant forms represent a growing problem (MRSA).
-Most common staphylococcal species to cause Staph infections.
-Presence of S. aureus does not always indicate infection.
Methicillin-resistant Staphylococcus aureus (MRSA)
MRSA: any strain of S. aureus that has developed, through the process of natural selection, resistance to beta-lactam antibiotics, which include the penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and the cephalosporins. Note: Not more intrinsically virulent than other strains of Staphylococcus aureus, just more difficult to treat.
MSSA: strains that are still sensitive to standard antibiotics.
S. aureus most commonly colonizes the anterior nares (the nostrils). The rest of the respiratory tract, open wounds, intravenous catheters, and the urinary tract are also potential sites for infection.
MRSA is especially troublesome in hospitals, prisons and nursing homes, where patients with open wounds, invasive devices, and weakened immune systems are at greater risk of infection than the general public.
The initial presentation of MRSA is small red bumps that resemble pimples, spider bites, or boils; they may be accompanied by fever and, occasionally, rashes. Within a few days, the bumps become larger and more painful; they eventually open into deep, pus-filled boils.
Other abbreviations: CA-MRSA: community-associated MRSA. HA-MRSA: hospital acquired.
People are very commonly colonized with CA-MRSA and are completely asymptomatic. The most common manifestations of CA-MRSA are simple skin infections, such as impetigo, boils, abscesses, folliculitis, and cellulitis.
Individuals at greatest risk:
People with weak immune systems (HIV/AIDS, lupus, or cancer sufferers; transplant recipients, severe asthmatics, etc.)
Intravenous drug users
Users of quinolone antibiotics
Young children and the elderly
College students living in dormitories
People staying or working in a health care facility for an extended period of time
People who spend time in confined spaces with other people, including occupants of homeless shelters and warming centers, prison inmates, military recruits in basic training, etc.
Veterinarians, livestock handlers, and pet owners.
Healthcare provider-to-patient transfer is common, especially when healthcare providers move from patient to patient without performing necessary hand-washing techniques between patients.
Restricting antibiotic use
: Glycopeptides, cephalosporins and in particular quinolones are associated with an increased risk of colonisation of MRSA. Reducing use of antibiotic classes that promote MRSA colonisation, especially fluoroquinolones, is recommended in current guidelines.
: The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions. Generally, the most common agents/regimens are listed first. Listed dosages may need to be adjusted for renal dysfunction.
Staphylococcus aureus Methicillin susceptible (MSSA)
500mg orally four times daily
600mg IV every 6 or 8 hours or 300mg orally tid or qid
DS (TMP-SMX) po bid
500 mg po qid
Nafcillin 1-2 grams IVPB q4-6 hours
1 to 2 g IV every eight hours
Vancomycin 1 gram ivpb q12h (patient-specific dosing required)
Staphylococcus aureus Methicillin-resistant (MRSA)
LOW-MIC, high susceptibility: clindamycin, Bactrim (TMP-SMX), or doxycycline
Vancomycin - (patient-specific regimen - trough goal 15-20 mcg/ml)
Linezolid 600 mg orally or IV q12h
6 mg/kg IV once daily. - NOT FOR PNEUMONIA
600mg IV q12h
Quinupristin-Dalfopristin 7.5 mg/kg IV q8h
10 mg/kg IV every 24hours
Infectious Disease Section References
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CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006. fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6.
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