Treatment Guidelines for Skin and Soft Tissue MRSA Infection

Centers for Disease Control and Prevention. (2009). National MRSA education initiative: Preventing MRSA skin infections. http://www.cdc.gov/mrsa/mrsa_initiative/skin_infection/index.html. Retrieved October 28, 2009.

Gould, F.K., Brindle, R., Chadwick, P.R., Fraise, A.P., Hill, S., Nathwani, D., et al. (2009). Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the united kingdom. Journal of Antimicrobial Chemotherapy, 63(5), 849-861.

Treatment of skin and soft tissue infections (SSTIs) caused by MRSA may involve incision and drainage of the abcess or boil, oral antibiotics, or IV antibiotics depending on the severity of the infection and the overall health of the patient. Incision and drainage of an abcess involves a health care provider making a small incision into the abcess, discharging any drainage, and packing the wound with sterile material if the incision is large (there are no specific guidelines for when packing is indicated). The packing material is removed within a day or two so that the wound may heal.

Incision and drainage is often sufficient to treat small abcesses without the need for systemic antibiotics. When antibiotic treatment is indicated, e.g. when there is a surgical site infection or an abcess with cellulitis, a culture and sensitivity should be performed to determine the most appropriate antibiotic. Doxycline, trimethoprim-sulfamethoxazole, or clindamycin are often the first choices for treatment. If the organism is not susceptible to these drugs, then oral glycopeptides, linezolid, or co-trimoxazole may be tried. Parenteral therapy with glycopeptides or daptomycin may treat moderately severe to severe cases of SSTIs. Vancomycin is generally reserved for severe cases as there is concern among the field about immerging vancomycin resistant strains of Staphylococcus aureus (VRSA). There are also a number of new antimicrobial agents used to treat SSTIs caused by MRSA that I will not mention here. It should be noted that MRSA is resistant to all beta-lactam agents such as the penicillins and cephalosporins. Fluoroquinolones and macrolides are also not recommended for treatment of MRSA SSTIs because resistance is common.

During treatment for SSTIs, hand hygiene, contact precautions, and proper wound care should be emphasized to patients and caregivers. Strategies to eliminate MRSA carriage among colonized individuals should not be implemented during active infection. Furthermore, the efficacy of these strategies, including oral antibiotics and topical antimicrobial agents, has not been well established.