The Management of Infection and Colonization due to Methicillin-ResistantStaphylococcus aureus: A CIDS/CAMM Position Paper

Andrew E Simor,Mark Loeb,The Cids/Camm Guidelines Committee the CIDS/CAMM Guidelines Committee

doi:10.1155/2004/531434

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is being seen with greater frequency in most hospitals and other health care facilities across Canada. The organism may cause life-threatening infections and has been associated with institutional outbreaks. Several studies have confirmed that MRSA infection is associated with increased morbidity and mortality compared with infections caused by susceptible strains, even when the presence of comorbidities is accounted for. Treatment of MRSA infection is complicated by the fact that these organisms are resistant to multiple antimicrobial agents, so treatment options are limited. The effectiveness of decolonization therapy (attempting to eradicate MRSA carriage) is also uncertain. This paper reviews the medical management of MRSA infections, discusses the potential role of decolonization and provides an overview of evidence to support recommended infection control practices.

Highlights

La prise en charge de l’infection et de la colonisation secondaires au Staphylococcus aureus méthicillinorésistant : Une déclaration de principe de la SMCI et de l’ACMM
The past few decades have witnessed the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a major hospital-acquired pathogen worldwide [1,2,3,4]
MRSA was first reported in Canada in 1981 [5], MRSA rates in Canadian hospitals have only increased substantially in the last few years

Summary

Skin or soft tissue

If MRSA only colonized patients, there would be little reason for concern. 20% to 60% of patients identified as being colonized with MRSA in hospital subsequently develop an MRSA infection [12]. In the past few years, several new agents with in vitro activity against resistant Gram-positive organisms have become available but clinical experience with these drugs against serious MRSA infections, including bacteremia, is still limited. New carbapenems (eg, L-695,256 and SM-17466) able to bind to PBP 2a with a high degree of affinity have been developed These drugs appear to be active in vitro against MRSA strains [89,90] and L-695,256 appears to be as effective as vancomycin in an animal model of endocarditis [89]. Newer fluoroquinolones and desfluoroquinolones (eg, garenoxacin, formerly BMS 284756) have been developed with enhanced activity against Gram-positive organisms [94] These agents appear to be more active in vitro against staphylococci, including MRSA, than ciprofloxacin, levofloxacin and gatifloxacin. Other relevant factors include the susceptibility of the MRSA strain to the antimicrobial agent being used for TABLE 2 Summary of characteristics and results of clinical trials of antimicrobial agents used for eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization

Results

Findings

INFECTION CONTROL STRATEGIES FOR THE MANAGEMENT OF MRSA IN HOSPITALS