Updated guidelines on management of CA-MRSA infections

The Buzz: Updated guidelines clarify approach to this growing problem
Citation: Clinical Infectious Diseases 2011:52  http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full.pdf
Summary: Community acquired methicillin-resistant S. Aures (CA-MRSA) infections continue to be on the rise and knowing the appropriate treatment and prevention guidelines is crucial. The Infections Disease Society of America released updated guidelines for the management of skin and soft tissue infections due to CA-MRSA which include the following key points:
- The primary treatment for cutaneous abscess is immediate incision and drainage.
- Antibiotic treatment should be also used for any of the following: multiple sites of infection, signs of systemic infection (fever, etc), rapidly growing infection, concomitant cellulitis, extremes of age, immunocompromise, significant comorbidities, difficult area to drain (e.g. face, hand, genitalia), lack of response to I&D alone.
- For cellulitis with purulence, antibiotic coverage should include empiric CA-MRSA coverage (Bactrim DS 1-2 po bid, Doxy 100 bid, Clinda 300-450 tid, linezolid). Duration of treament is 5-10 days and should be individualized.
- For cellulitis without purulence, empiric beta-hemolytitc streptococcus coverage should be used (Bactrim, Keflex 500 qid, Clinda) but CA-MRSA coverage is likely not needed.
-The use of rifampin as a single agent or as adjunct therapy is not indicated 


The management of recurrent infections with CA-MRSA was also addressed and included:
- Education around frequent hand washing and good hygiene practices
- Avoid reusing personal grooming items (disposable razors, e.g.) and wash all towels/clothes/linens that come in contact with open wounds.
- Focus cleaning efforts on high-touch surfaces like doorknobs and counter tops.
- Decolonization protocols may also be employed and include twice daily intranasal mupirocin 2% for 5-14 days, bathing with antibacterial soaps (chlorhexadine) for 5-10 days, and dilute bleach baths (1/4 cup bleach to 1/4 tub or 13 gallons water) for 15 min twice weekly for up to 3 months.
- Decolonization of household contacts can be considered.

By: Spencer Blackman MD