Protocols for treating methicillin-resistant Staphylococcus aureus, or MRSA, infections vary widely in the United States, according to the Infectious Diseases Society of America, or IDSA. To help clinicians manage this potentially lethal contagion, the organization has released its first guidelines for the treatment of MRSA infection.
The evidence-based guidelines are intended to help physicians determine the most appropriate treatment for both uncomplicated and invasive infections due to the common bacterium, which is responsible for 60 percent of skin infections treated in U.S. emergency rooms.
More than 90,000 Americans were infected with the invasive form of the disease in 2005, the IDSA said, and more than 18,000 of those people died.
"MRSA has become a huge public health problem, and physicians often struggle with how to treat it," said Catherine Liu, M.D., lead author of the guidelines and assistant clinical professor in the Division of Infectious Diseases at the University of California, San Francisco, in a Jan. 5 news release(www.idsociety.org). "The guidelines establish a framework to help physicians determine how to evaluate and treat uncomplicated as well as invasive infections."
The guidelines, which were published online(cid.oxfordjournals.org) Jan. 4 and will appear in the Feb. 1 issue of Clinical Infectious Diseases, cover treatment options for both adults and children. They also call for the development of new and improved antibiotics to treat MRSA.
Among the wide range of topics covered in the guidelines document are:
- how to manage skin and soft-tissue infections likely caused by community-associated MRSA;
- how to treat recurrent skin infections;
- recommendations regarding use of vancomycin -- including dosing -- and other antibiotics;
- how to manage invasive infections, such as pneumonia, and infections in the bones, joints, blood or heart; and
- how to treat newborns who are infected with MRSA.
Regarding the management of uncomplicated infections typically seen in an office setting, the guidelines note that use of antibiotics is not always necessary. For simple abscesses or boils, incision and drainage alone is likely to be adequate.
However, antibiotic therapy is recommended for abscesses associated with any of the following conditions:
- severe or extensive disease;
- rapid progression of disease in the presence of associated cellulitis;
- signs and symptoms of systemic illness;
- associated comorbidities or immunosuppression;
- extremes of age;
- abscess in an area difficult to drain, such as the face, hands or genitalia;
- associated septic phlebitis; and
- lack of response to incision and drainage.
In addition, patient education about personal hygiene and appropriate wound care is recommended for all patients with recurrent skin and soft-tissue infections.
The guidelines were reviewed and endorsed by the Pediatric Infectious Diseases Society, the American College of Emergency Physicians, and the American Academy of Pediatrics. According to Liu, they will be updated as new information becomes available and as new antibiotics are created.