"New" Guidelines – MRSA (Acute) Infections

The Silent Role of Biofilms in Chronic Disease Forums Biofilm Community The Standard of Care "New" Guidelines – MRSA (Acute) Infections

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    • #2978 Score: 0
        2 pts

        Once again, here’s another failure in the standard of care:

        – reliance on culture-based technology, rather than molecular diagnostics;
        – failure to recognize that bacteria form biofilms, and become polymicrobial communities that resist antibiotic treatment;
        – that inappropriate, sub-inhibitory antibiotics can actually make the infection worse;
        – failure to distinguish between planktonic (acute) infections and biofilm (chronic) infections.

        This is very sad news: it shows no advancement in the diagnosis and treatment of chronic bacterial infections.

        New MRSA guidelines released

        The Infectious Diseases Society of America has developed its first clinical practice guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.

        Methicillin-resistant Staphylococcus aureus (MRSA) is the predominant cause of skin infections among patients presenting to the emergency department, and it can also cause more serious, invasive infections that account for about 18,000 deaths in the United States per year.

        “The guidelines establish a framework to help physicians evaluate and treat uncomplicated, as well as invasive, infections due to MRSA,” Catherine Liu, MD, lead author of the guidelines, told Orthopedics Today’s sister publication, Infectious Disease News.

        Soft-tissue infections

        The guidelines address a variety of infections caused by MRSA, including skin and soft-tissue infections, recurrent skin and soft-tissue infections, invasive infections such as bacteremia and endocarditis, pneumonia, osteomyelitis and central nervous system infections.

        For skin and soft-tissue infections, incision and drainage are the recommended primary treatment, and antibiotic therapy is only recommended for severe or extensive disease and for those with associated comorbidities. For outpatients with purulent cellulitis, empirical therapy for community-associated MRSA (CA-MRSA) is recommended pending culture results. Treatment for beta-hemolytic streptococci is likely unnecessary for this group.

        Nonpurulent cellulitis

        However, for those with nonpurulent cellulitis, empirical treatment with a beta-lactam antibiotic for beta-hemolytic streptococci is recommended. The role of CA-MRSA for this particular entity is unknown. If patients do not respond to the beta-lactam antibiotic, or if they are systemically ill, then treatment for MRSA should be given.

        Patients with recurrent MRSA skin and soft-tissue infections should be educated on proper wound care and personal and environmental hygiene. If a recurrence occurs despite these measures, decolonization strategies may be offered in the form of nasal decolonization and/or topical body decolonization regimens. Further research is needed to determine the optimal approach to prevent recurrent infections, the panel noted.

        “In addition to antibiotic therapy, the management of all MRSA infections should include identifying, eliminating and/or debriding the primary source and other sites of the infection,” Liu said.

        Regimen and doses

        For adults with uncomplicated MRSA bacteremia, a 2-week course of intravenous vancomycin or daptomycin (Cubicin, Cubist Pharmaceuticals) is recommended. In adults with complicated MRSA bacteremia or endocarditis, 4 to 6 weeks of the treatment is recommended. Follow-up blood cultures should be performed at 2 to 4 days, and as needed thereafter, to document that the infection has been cleared.

        The guidelines also recommend that when intravenous vancomycin is used, the dosage should be 15 mg/kg to 20 mg/kg per dose, every 8 to 12 hours and not exceed 2 g per dose. Trough vancomycin concentrations should be used to guide dosing and achieve target concentrations of 15 mcg/mL to 20 mcg/mL in patients with serious MRSA infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia and severe skin and soft-tissue infections, such as necrotizing fasciitis.

        The guidelines also discuss the management of patients with MRSA isolates with reduced susceptibility to vancomycin, vancomycin treatment failures and the use of alternatives to vancomycin therapy. — by Emily Shafer


        Liu C. Clin Infect Dis. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. 2011;53:285-322.

      • #3444 Score: 0
          2 pts

          If you are new to the inner workings of bacterial biofilms, this animation we produced will help you understand the critical differences between acute (planktonic) and chronic (biofilm) infections:

          YouTube – What Are Bacterial Biofilms? A Six Minute Montage

          Between the interviews with biofilm experts, and the animations, you’ll start to understand how the standard of care has failed so many Americans with chronic bacterial infections.

        • #2979 Score: 0
            2 pts

            The full guidelines are shown here in html or PDF. Notice the curious disclaimer in the footnotes. Also note the acknowledgements, financial support and conflicts of interest on page 291 of the full text document.

            Financial support. IDSA.

            Potential conflicts of interest. H.F.C. has received honoraria and research grants and has served as a consultant to Cubist, Ortho-McNeil,Pfizer, Theravance, and Targanta. S. E. C. has received honoraria from Forest and RibX, has served as a consultant for Merck and has received research support from Astellas, Cubist and AdvanDx. R.D. has received research funding from Pfizer, Clorox, Sanofi Pasteur, Sage, and GeneOhm. S.L.K. has received grant funding from Pfizer, has served as MRSA Leadership Advisor to Pfizer, and is participating in a pediatric daptomycin study. A.W.K. has received honoraria and grants from Cubist Pharmaceuticals, Merck, Wyeth, and Pfizer and has served as a consultant for Cubist Pharmaceuticals, Theravance, Astellas, Pfizer, Merck, and OrthoMcNeil and has owned stock from Cubist Pharmaceutical, Pfizer, and Johnson and Johnson. D.P.L. has received research support from Cubist, Johnson & Johnson, and Theravance and has served as a speaker for Cubist. B.E.M. has served as a consultant and received research support from Johnson & Johnson, Astellas, Pfizer, Cubist, Theravance, Targanta, Sanofi- Aventis, Vicuron Pharmaceuticals, and Wyeth-Ayerst. M.R. has received grants and or has served as a consultant speaker for the Pfizer, Cubist, Theravance/Astellas, Targanta, and Johnson & Johnson. D.A.T. has served on the advisory board to Pfizer, Ortho-McNeil, Astellas, Schering-Plough, and Replidyne. All other authors: no conflicts.

            Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children: Executive Summary


            Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.


            It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

            Received October 28, 2010.
            Accepted November 17, 2010.

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