MRSA (methicillin resistant staph areus) - CSHP-BC Branch

5/3/2007New AntibioticsCases revisted• DAPTOMYCIN (CUBICIN)• Acitve against MRSA MSSA STREP• Cyclic lipopeptide• Tigecyclin (Tigacyl)– 1 st glycylcycline– Active against mrsa mssa strep and gram negs• Both FDA approved: Health Canada pending• 1.) 48 year old Male, history of “superbug”:treatment?• Swab plus 2 of: Clinda/Septra/Doxy/Rifampin• 2.) 26 year old Female, IV drug user, antecubitalabscess: Organism? Treatment?• Organism = MRSA!• Treatment = I and D +/- combo therapyCases revisited• Husband and Wife, abscesses• More info?• Treated with keflex 3 times for previousepisodes• Almost certainly MRSA based on multipleabscesses and multiple courses of Keflex eventhough no other identifiable risk factors• Treatment?• I and D, Swab, Combination therapySummary• CA-MRSA is highly prevalent as a cause of skinand soft tissue infections• CA-MRSA = virulent/aggressive• CA-MRSA will replace MSSA in a matter of years• Abscess/purulent skin infection = MRSA untilproven otherwise• Serious/life threatening skin and soft tissueinfections must be treated with antibiotics activeagainst both MRSA/MSSA and strepSummaryQUESTIONS ?!?!• Septra, Doxy, Rifampin and Clinda can beused in combination when oral therapy isindicated.• Vancomycin remains the agent of choicewhen iv therapy is indicated• New antimicrobials may soon be available• Small uncomplicated abscesses can still betreated with primary I and D alone.9