A practical guide to community-acquired MRSA
As the number of CA-MRSA skin and soft tissue infections continues to grow, it’s important to know which patients are at greatest risk and which evidence-based treatment protocols to turn to when needed.
How to manage recurrent infections
Management of recurrent CA-MRSA SSTIs in the outpatient setting poses a challenge. Following successful treatment of active infection, you may want to attempt decolonization in select patients. Those with repeated MRSA infections despite adequate hygiene measures or with a high probability of reexposure to colonized close contacts may be treated, although the evidence supporting such protocols is lacking.8,13
Acceptable procedures described by IDSA include nasal mupirocin twice daily for 5 to 10 days, mupirocin plus topical antiseptic solution (eg, chlorhexidine, triclosan, or povidone-iodine) for 5 to 14 days, or mupirocin plus dilute bleach baths (1 teaspoon bleach/gallon of water) twice weekly for 15 minutes over 3 months.13 Although antibiotics are generally only recommended for active infection, the combination of rifampin and an antibiotic with MRSA coverage may be used for 1 to 2 weeks in cases of recurrent infections despite recommended hygiene and topical decolonization measures.13,15,16 Rifampin is not recommended as monotherapy for MRSA infection or decolonization.13
Unfortunately, even in cases where eradication is initially successful, about half of those with subsequent negative MRSA cultures will test positive before the end of a year.16 With recurrent or severe infections or immunocompromised patients, it’s advisable to consider an infectious disease consult.
CASE › The patient’s lesion did not require incision as it was already draining. He received a prescription for doxycycline hyclate 100 mg BID for 7 days (since there was evidence of rapidly progressing cellulitis) and was instructed to return to the clinic in 48 hours.
When he returned to the clinic, the patient stated that the pain had improved and the wound was no longer oozing. Culture results confirmed MR SA sensitive to TMP-SMX, doxycycline, and clindamycin. Examination showed improved erythema, a dry wound, and no pain on palpation. He was given a patient information handout on MRSA infection and advised to return to the clinic if the wound did not completely heal within the next 7 days.
