Author – Dr. Catherine Liu
Assistant Clinical Professor, Division of Infectious Diseases, University of California
Methicillin-resistant Staphylococcus aureus (MRSA) – both healthcare- and community-associated – has become an enormous public health problem. MRSA is responsible for about 60 percent of skin and soft tissue infections seen in emergency rooms, and invasive MRSA kills about 18,000 people annually. Clinicians often struggle with how best to treat MRSA, resulting in wide variations in approaches to therapy. The growing clinical impact of MRSA, particularly community-acquired infections, prompted the Infectious Diseases Society of America to develop its first treatment guidelines for MRSA. Charged with reviewing the evidence and developing the guidelines, my coauthors and I aimed to create a framework to help clinicians evaluate and treat uncomplicated and invasive MRSA infections. As with all IDSA guidelines, they are voluntary and are not meant to replace clinical judgment, but rather synthesize the available evidence and support the decision-making process, which must be individualized for each patient.
The guidelines address 11 topics commonly encountered by adult and pediatric clinicians. They provide guidance in the management of: skin and soft tissue infections including recurrent infections; use of intravenous vancomycin; and invasive infections, such as pneumonia, and infections in the bones, joints, blood or heart.
In the midst of our battle against drug resistance, IDSA hopes the guidelines highlight the importance of the judicious use of antibiotics. For instance, the bulk of the evidence so far suggests incision and drainage may be adequate for the treatment of simple abscesses or boils. We’re eagerly awaiting the results of two large, NIH-sponsored, randomized trials to further clarify the role of antibiotics in this setting.
The guidelines also call for better drugs to treat MRSA. Although a number of new drugs have been developed and FDA-approved, we have yet to discover the golden bullet.
Of course, additional research is necessary on MRSA and as with all IDSA guidelines, these recommendations will evolve as new information and antibiotics become available.
See the full-text “Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children,” or pick up the Feb. 1 issue of Clinical Infectious Diseases.