New Guidelines Issued for MRSA Treatment
By Elizabeth Mechcatie
Elsevier Global Medical News
The Infectious Diseases Society of America rolled out its first-ever guidelines for treating methicillin-resistant Staphylococcus aureus – including recommendations to battle the growing threat posed by MRSA-related skin and soft-tissue infections.
The comprehensive guidelines also outline evidence-based approaches on topics ranging from personal hygiene and wound care to antibiotic therapies for invasive MRSA, as well as options after vancomycin treatment failure.
The guidelines, published online Jan. 5 (Clin. Infect. Dis. 2010 [doi:10.1093/cid/ciq146]). provide adult and pediatric clinicians with guidance on how to treat relatively uncomplicated MRSA infections, as well as more serious infections, according to Dr. Catherine Liu, lead author of the guidelines and assistant clinical professor in the division of infectious diseases, University of California, San Francisco. The recommendations cover community- and hospital-associated MRSA infections, she added.
MRSA infections account for about 60% of skin infections seen in U.S. emergency departments, and invasive MRSA infections cause about 18,000 deaths a year, according to the Infectious Diseases Society of America (IDSA).
The evidence-based guidelines, which have been endorsed by the Pediatric Infectious Diseases Society, the American College of Emergency Physicians, and the American Academy of Pediatrics, are voluntary and “are not intended to take the place of a doctor’s judgment, but rather support the decision-making process, which must be individualized according to each patient’s circumstances,” according to a statement issued by IDSA, which funded the guidelines.
A 13-member expert panel reviewed hundreds of scientific studies, papers, and presentations to create the recommendations. The first topic addressed is the management of skin and soft tissue infections caused by MRSA, which is the predominant organism causing purulent skin infections in patients who present to emergency departments, Dr. Liu said in an interview.
The guidelines address several types of skin infections, including abscesses and cellulitis, and recommend specific antibiotic choices depending on type of infection as well as situations in which they may not be indicated.
Other topics covered include the management of MRSA pneumonia, bacteremia, and infective endocarditis; central nervous system infections; and bone and joint infections. Additional sections review the role of adjunctive therapies in the treatment of MRSA infections, MRSA infections in neonates, and specific recommendations on vancomycin dosing and monitoring.
IDSA, which funded development of the guidelines, will update them as more information and newer antibiotics become available. Of the expert panel’s13 members, 9 reported having potential conflicts of interest that included honoraria or research support from, or having served as a consultant or adviser to, pharmaceutical companies, including Astellas, Cubist Pharmaceutical, Forest, Merck, Ortho-McNeil, Pfizer, Sanofi-Aventis, Schering-Plough, and Theravance. The remaining authors of the guidelines, including the lead author, Dr. Catherine Liu, reported no conflicts.
Online January 13, 2011