Review articleEmpirical therapy in Methicillin-resistant Staphylococcus Aureus infections: An Up-To-Date approach
Section snippets
Bacteremia
MRSA bacteremia and resulting or resultant infective endocarditis warrant the most immediate initiation of antimicrobials. Despite various concerns regarding increased resistance and creeping MICs, suboptimal killing, and challenging dosing pharmacokinetics that may require patient individualization; vancomycin remains the first line therapy for these invasive MRSA infections. Daptomycin has demonstrated non-inferiority to vancomycin and could be considered empirically in the setting of
Skin infections
In the United States, MRSA is the most common cultured organism in the setting of skin–infection lesions [114], [115]. Following the epidemiologic pattern of these infections, a majority of CA-MRSA infections are skin and soft tissue infection (SSTI) [116], [117], [118]. For this reason, empiric selections of antimicrobials in the setting of moderate SSTI are most applicable for CA-MRSA. For any SSTI (including MRSA) with abscess formation, the recommended primary management is incision and
Pneumonia
In any case of pneumonia where MRSA is a suspected pathogen, empiric therapy with vancomycin or linezolid should be initiated. Wunderink et al. have demonstrated that in the setting of MRSA nosocomial pneumonia, those patients treated with linezolid achieved greater clinical efficacy at the end of study, in comparison with patients treated with dose-adjusted vancomycin, though 60-day mortality was similar in the two treatment groups [36]. Additionally, this study demonstrated improved
Bone-joint infections
Appropriate initial management of bone and joint infections due to MRSA, including osteomyelitis, includes surgical debridement with drainage of any adjacent abscess, and initiation of antimicrobial therapy. Following initial surgical management, vancomycin or daptomycin are the preferred initial antimicrobials [10], [125]. This is despite concerns noting high rates of failure associated with vancomycin [126], though these high rates of failure have led to some expert recommendations for
Conflict of interest
AV has no conflict of interest. JS serves as a consultant for Merck and Allergan and owns stock in Pfizer.
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2019, European Journal of Pharmaceutical SciencesCitation Excerpt :This health threat may worsen because of drug-resistant S. aureus, such as methicillin-resistant S. aureus (MRSA) (Bassetti et al., 2013; Dai et al., 2018). MRSA, associated with high morbidity and mortality in both humans and animals, is the most common bacteria (VanEperen and Segreti, 2016). It can cause pneumonia sepsis and skin infections and has been proved to be highly resistant to many antibiotics (Woods and Colice, 2014; Enright et al., 2002; Mihu et al., 2015).