Decolonization may be considered if a patient develops a recurrent infection despite good personal hygiene and wound care, or if other household members develop infections. Strategies for decolonization include nasal decolonization with mupirocin twice per day for five to 10 days, or nasal decolonization with mupirocin twice per day for five to 10 days plus topical body decolonization with a skin antiseptic solution e.
Dilute bleach baths can be made with 1 teaspoon of bleach per 1 gallon of water or one-fourth cup per one-fourth bathtub or 13 gallons of water and are given for 15 minutes twice per week for three months. Oral antimicrobial therapy is recommended only for treating active infection and is not routinely recommended for decolonization.
An oral agent in combination with rifampin, if the strain is susceptible, may be considered if infections recur despite these measures. If household or interpersonal transmission is suspected, patients and contacts should be instructed to practice personal and environmental hygiene measures.
In symptomatic contacts, nasal and topical body decolonization strategies may be considered after treating the active infection. Decolonization strategies also may be considered in asymptomatic household contacts.
The role of cultures in managing recurrent skin and soft-tissue infections is limited. Screening cultures before decolonization are not routinely recommended if at least one of the previous infections was caused by MRSA. Surveillance cultures after a decolonization regimen are not routinely recommended if there is no active infection. Uncomplicated bacteremia is defined as positive blood culture results and the following: exclusion of endocarditis; no implanted prostheses; follow-up blood cultures performed on specimens obtained two to four days after the initial set that do not grow MRSA; defervescence within 72 hours of initiating effective therapy; and no evidence of metastatic sites of infection.
Recommended treatment for adults with uncomplicated bacteremia includes vancomycin or daptomycin at a dosage of 6 mg per kg intravenously once per day for at least two weeks. For adults with complicated bacteremia positive blood culture results without meeting criteria for uncomplicated bacteremia , four to six weeks of therapy is recommended, depending on the extent of infection. Some experts recommend higher dosages of daptomycin 8 to 10 mg per kg intravenously once per day.
For adults with infective endocarditis, intravenous vancomycin or daptomycin 6 mg per kg intravenously once per day for six weeks is recommended. Adding gentamicin or rifampin to vancomycin is not recommended in patients with bacteremia or native valve infective endocarditis.
Additional blood cultures two to four days after initial positive cultures and as needed thereafter are recommended to document clearance of bacteremia. Echocardiography is recommended for all adults with bacteremia. Transesophageal echocardiography is preferred over transthoracic echocardiography. Evaluation for valve replacement surgery is recommended if any of the following are present: large vegetation greater than 10 mm in diameter , occurrence of one or more embolic events during the first two weeks of therapy, severe valvular insufficiency, valvular perforation or dehiscence, decompensated heart failure, perivalvular or myocardial abscess, new heart block, or persistent fevers or bacteremia.
Patients with infective endocarditis and a prosthetic valve should be treated with intravenous vancomycin and rifampin mg orally or intravenously every eight hours for at least six weeks , plus gentamicin 1 mg per kg intravenously every eight hours for two weeks. Early evaluation for valve replacement surgery is recommended. In children, intravenous vancomycin 15 mg per kg every six hours is recommended for treating bacteremia and infective endocarditis.
The duration of therapy may range from two to six weeks depending on the source, the presence of endovascular infection, and metastatic foci of infection. Data regarding the safety and effectiveness of alternative agents in children are limited, although daptomycin 6 to 10 mg per kg intravenously once per day may be an option.
Clindamycin and linezolid should not be used if there is concern of infective endocarditis or an endovascular source of infection, although they may be considered in children with bacteremia that rapidly clears and is not related to an endovascular focus.
Data are insufficient to support the routine use of combination therapy with rifampin or gentamicin in children with bacteremia or infective endocarditis. The decision to use combination therapy should be individualized. Echocardiography is recommended in children with congenital heart disease, bacteremia lasting more than two to three days, or other clinical findings suggestive of endocarditis.
Treatment options for health care—associated MRSA or community-associated MRSA pneumonia include seven to 21 days of intravenous vancomycin or linezolid, or clindamycin mg orally or intravenously three times per day if the strain is susceptible. In patients with MRSA pneumonia complicated by empyema, antimicrobial therapy should be used with drainage procedures.
In children, intravenous vancomycin is recommended for treating MRSA pneumonia. If the patient is stable without ongoing bacteremia or intravascular infection, clindamycin 10 to 13 mg per kg intravenously every six to eight hours for a total of 40 mg per kg per day can be used as empiric therapy if the clindamycin resistance rate is low e.
Patients can be transitioned to oral therapy if the strain is susceptible. Linezolid is an alternative option. The mainstay of therapy for osteomyelitis is surgical debridement with drainage of associated soft-tissue abscesses. But because it takes about 48 hours for the bacteria to grow, newer tests that can detect staph DNA in a matter of hours are now becoming more widely available.
Both health care-associated and community-associated strains of MRSA still respond to certain antibiotics. Doctors may need to perform emergency surgery to drain large boils abscesses , in addition to giving antibiotics. In some cases, antibiotics may not be necessary. For example, doctors may drain a small, shallow boil abscess caused by MRSA rather than treat the infection with drugs. While you may initially consult your family doctor, he or she may refer you to a specialist, depending on which of your organs is affected by the infection.
For example, he or she may refer you to a doctor trained in skin conditions dermatologist or a doctor trained in heart conditions cardiologist.
A person should make sure that they take the whole course of antibiotics exactly as the doctor prescribes. Some people stop taking the drugs after the symptoms disappear, but this can increase the risk of the infection coming back and becoming resistant to treatment.
MRSA results from infection with bacterial strains that have acquired resistance to particular antibiotics. MRSA can spread from person to person through direct skin-to-skin contact or when a person with MRSA bacteria on their hands touches an object that another person then touches. MRSA bacteria can survive for a long time on surfaces and objects, including fabrics and door handles. In , scientists investigated how long resistant staph could survive on five common hospital fabrics. They injected the fabrics with colony-forming units of staph and observed the reactions over the following days.
These results demonstrate the need for thorough contact control and meticulous disinfection procedures to limit the spread of bacteria. MRSA frequently causes illness in people with a compromised immune system who spend time in the hospital and other healthcare facilities.
A person will have a higher risk of developing healthcare-associated MRSA in the hospital if they have had surgery recently or if they have:. MRSA is less common outside a healthcare setting. If it does occur, it is more likely to be a skin infection, although some people develop pneumonia and other infections. People can reduce the risk by practicing appropriate hand washing, keeping wounds clean, avoiding sharing personal items — such as towels and razors, and seeking early treatment if any symptoms of an infection appear.
Children can develop MRSA through an open wound. Find out how to recognize it and what to do. Many people carry MRSA bacteria in their mucosa, for instance, inside the nose, but they may never develop symptoms that indicate an active infection.
You can get this type of MRSA infection through direct contact with an infected wound or contaminated hands. You can also get the infection through contact with contaminated linens or poorly sanitized surgical instruments. CA-MRSA is associated with infections transmitted through close personal contact with a person who has the infection or through direct contact with an infected wound.
This type of MRSA infection may also develop because of poor hygiene , such as infrequent or improper handwashing. Areas that have increased body hair, such as the armpits or back of the neck, are more likely to be infected. Areas that have been cut, scratched, or rubbed are also vulnerable to infection because your biggest barrier to germs — your skin — has been damaged.
The infection usually causes a swollen, painful bump to form on the skin. The bump may resemble a spider bite or pimple. It often has a yellow or white center and a central head. Sometimes an infected area is surrounded by an area of redness and warmth, known as cellulitis. Pus and other fluids may drain from the affected area. Some people also experience a fever. Diagnosis begins with a medical history assessment and physical examination. Samples will also be taken from the site of infection.
The types of samples obtained to help diagnose MRSA include the following:. Wound samples are obtained with a sterile cotton swab and placed in a container. Sputum is the substance that comes up from the respiratory tract during coughing. A sputum culture analyzes the sputum for the presence of bacteria, cell fragments, blood , or pus. People who can cough can usually provide a sputum sample easily.
Those who are unable to cough or who are on ventilators may need to undergo a respiratory lavage or bronchoscopy to obtain a sputum sample. Respiratory lavage and bronchoscopy involve the use of a bronchoscope, which is a thin tube with a camera attached.
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