Management of MRSA

All infections due to MRSA should be managed on an individual basis in discussion with Consultant Microbiologist or ID Physician and in accordance with individual sensitivity patterns.

For decolonisation regimes and further management of colonisation due to MRSA please follow the Procedure Management of Staphylococcus Aureus (MSSA/MRSA).

The aim is not to eradicate, but to reduce the MRSA bio-burden to such a level that the cycle of colonisation to infection is prevented for the individual patient.  Bio-burden reduction will also reduce patient-to-patient transmission of MRSA.  The use of this regime without the removal of IV lines or urinary catheters will reduce the success. MRSA decolonisation prescription stickers are available on all wards.

Chlorhexidine gluconate 4% (Hibiscrub®)

Bathe daily for 5 days. Moisten skin and apply to all areas with special attention to the axillae, groins and perineum, and any other areas with known carriage. Use as a shampoo twice in the five days period (day 1 and 2).

For patients with exfoliative skin conditions or allergy to chlorhexidine

Use Prontoderm as per  (Elective Surgery)

Prontoderm pack as per (Elective Surgery).

Body system Treatment Choice Comments
Acute exacerbation of COPD (Non-pneumonic LRTI)
Duration of therapy 7 days		 Doxycycline 100mg PO q12h

Or

Clindamycin PO 600mg q6h plus
Sodium fusidate PO 500mg q8h

 Treat according to culture and sensitivity

Clindamycin should only be used if the strain is susceptible to erythromycin
Bronchiectasis 
Duration of therapy 7 days		 Doxycycline 100mg PO q12h
plus sodium fusidate PO 500mg q8h

Or

Clindamycin PO 600mg q6h
plus 
Sodium fusidate PO 500mg q8h or Rifampicin PO 600mg q12h

 Treat according to culture and sensitivity

Clindamycin should only be used if the strain is susceptible to erythromycin

Rifampicin and sodium fusidate should NOT be used as monotherapy but always in combination with another anti-MRSA agent. Discuss with Consultant Microbiologist before using regimes containing rifampicin
Pneumonia
Duration of therapy 2 weeks		 Vancomycin IV (dosed as per trust vancomycin guideline) +/- Sodium fusidate PO 500mg q8h or Rifampicin PO 600mg q12h Consider stepping down to oral therapy once patient is clinically stable.

Body system – MRSA Treatment Choice Comments
Urinary tract infections
Duration of therapy 7days		 Doxycycline PO 200mg q12h

Or

Trimethoprim PO 200mg q12h

Or

Nitrofurantoin PO 100mg q6h (for cystitis only)

 Lack of data on the efficacy of vancomycin. Vancomycin NOT recommended due to lack of data on efficacy, cost, toxicity and availability of other oral agents

Body system Treatment Choice Comments
Superficial eye infections Fusidic acid 1% MR eye drops One drop to be instilled into the affected eye (s) twice a day. Continue treatment for 2 days after symptoms have resolved Discuss alternative treatment options with microbiology if failure to respond to treatment or resistance to fusidic acid.
Deep eye and CNS infections Discuss with Ophthalmologist or Consultant Microbiologist for advice  

Body system Treatment Choice Comments
Uncomplicated skin and soft tissue infections 
Duration of therapy 7 days		 Doxycycline PO 100mg q12h Not suitable for severe infections where there is a high risk of bacteraemia or endocarditis
Severe skin and soft tissue infections where there is a high risk of bacteraemia or endocarditis
Duration of therapy 2 weeks		 Vancomycin IV (dosed as per trust vancomycin guideline)  
Severe skin and soft tissue infections that have failed therapy with single active agents
Duration of therapy 2 weeks		 Vancomycin IV (dosed as per trust vancomycin guideline)

Or

Doxycycline PO 100mg q12hplus sodium fusidate PO 500mg q8h

Or

Doxycycline PO 100mg q12h plus rifampicin PO 600mg q12h

 

 Treat according to culture and sensitivity results

Body system Treatment Choice Comments
IV infusion sites infections

Line removal is the mainstay of treatment

Duration of therapy is 2 weeks

 Remove the line

Trimethoprim PO 200mg q12h plus rifampicin PO 600mg q12h

Or

Trimethoprim PO 200mg q12h plus Sodium fusidate PO 500mg q8h

Or  Vancomycin IV (dosed as per trust vancomycin guideline)

 If severe infection

e.g. pus, cellulitis or tunnel infection are present;urgent line removal

Body system Treatment Choice Comments
Prosthetic Joint infection 
Duration of therapy to be discussed with microbiology		 Vancomycin IV (dosed as per trust vancomycin guideline) plus rifampicin PO 600mg q12h

Or

Vancomycin IV (dosed as per trust vancomycin guideline) plus sodium fusidate PO 500mg q8h

 Prolonged treatment often required
Bone and Joint Infections 
Duration of therapy to be discussed with microbiology		 Vancomycin IV (dosed as per trust vancomycin guideline) plus rifampicin PO 600mg q12h

Or

Vancomycin IV (dosed as per trust vancomycin guideline) plus sodium fusidate PO 500mg q8h

 Prolonged treatment often required
Oral antibiotics should be chosen according to culture/sensitivity results and discussed with microbiology