Staphylococcus aureus Paul G. Auwaerter, M. Minocycline A good choice for skin and skin structure infections due to S. Nafcillin Well-established agent for serious systemic S. Oxacillin Well-established agent for serious systemic S. Rifampin Excellent bactericidal agent against S. The clinical failure rate is higher for staphylococcal endocarditis treated with vancomycin than with alternate beta-lactam agents.
Use is thus reserved for MRSA or for patients with documented severe beta-lactam allergy. Must be given IV no oral absorption. No single dose should exceed 2g. Loading dose can be considered in patients who are critically ill. Trough concentrations are the most accurate method to guide dosing; obtain after steady state likely following 4 th or 5 th dose. For routine SSTI infections, 1g q12h dosing should be adequate.
No dose alteration required in renal or hepatic insufficiency. Side effects include thrombocytopenia, anemia, neutropenia as well as optic neuritis and irreversible peripheral neuropathy. Patient on both drugs should be monitored for mental status changes, myoclonus, diaphoresis and other symptoms of serotonin syndrome.
If the concern of serotonin effect may consider instead tedizolid which has a much lower risk of interaction. It is inactivated by pulmonary surfactant and cannot be used for pneumonia. The main side effect is myopathy; CK must be checked at least weekly. Cases of the emergence of resistance during therapy have been reported, particularly in patients without source control who have received prior vancomycin ; monitor for recurrent positive blood cultures during therapy.
Doxycycline A good choice for skin and skin structure infections due to S. Tigecycline FDA approved for skin and soft tissue infections. May cause red man syndrome and should not be used in pregnancy. Maybe slightly more nephrotoxic than vancomycin.
After an absence, the drug is now again available in the US. Concern with the drug is that studies have suggested a substantially higher rate of mortality in patients with diabetes or renal failure compared to those treated with vancomycin.
Tedizolid Oral and parenteral oxazolidinone FDA approved for short course therapy 6d for skin and skin structure infections. Dalbavancin Long-acting glycopeptide, FDA approved for skin and soft tissue infections. Oritavancin Long-acting glycopeptide, FDA approved for skin and soft tissue infections. Citation Auwaerter, Paul G. Johns Hopkins Guide , www.
Auwaerter PG. Staphylococcus aureus. The Johns Hopkins University; Accessed November 12, Auwaerter, P. The Johns Hopkins University. Staphylococcus Aureus [Internet]. Your free 1 year of online access expired. Log in to Johns Hopkins Guides. Forgot Your Password? Enter your username below and we'll send you an email explaining how to change your password.
Note: Your username may be different from the email address used to register your account. Forgot Your Username? Enter your email below and we'll resend your username to you. Contact Support If you need further assistance, please contact Support.
Show references Jameson JL, et al. Staphylococcal infections. In: Harrison's Principles of Internal Medicine. The McGraw-Hill Companies; Accessed Jan.
Holland TL, et al. Clinical manifestations of Staphylococcus aureus infection in adults. Fowler VG, et al. Clinical approach to Staphylococcus aureus bacteremia in adults. Merck Manual Professional Version. Staphylococcal staph food poisoning. Centers for Disease Control and Prevention. Menstrual cycle. Table 1 lists the costs of antibiotic therapy for S.
Antimicrobial therapy should be guided by the susceptibility profile of the organism. First-generation cephalosporins e. Vancomycin Vancocin should only be used for the treatment of MSSA in patients allergic to penicillins because of overuse and development of resistant organisms, and because clearance of bacteremia may be slow. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee.
Vancomycin is preferred for treatment in severe MRSA infections and is used only intravenously because the oral formulation is not readily absorbed from the gastrointestinal tract.
Vancomycin-intermediate susceptible and vancomycin-resistant strains of S. Even in patients with vancomycin-susceptible MRSA, there have been reports of treatment failure with vancomycin, which is thought to be because of heterogeneous subpopulations with varying susceptibility to vancomycin, 11 or associated with the presence of the regulatory gene agr group II polymorphism.
Linezolid Zyvox has bacteriostatic activity against S. It is included in the oxazolidinone class of drugs and has parenteral and oral formulations, with good oral bioavailability. One retrospective analysis 13 of a database from a prospective randomized trial suggested enhanced effectiveness of linezolid compared with vancomycin in MRSA nosocomial pneumonia. The rationale may be related to enhanced concentrations of linezolid in lung epithelial lining fluid.
The main adverse event associated with linezolid is bone marrow suppression, especially thrombocytopenia, which is increased with dosage and duration of therapy. Coadministration of selective serotonin reuptake inhibitors and adrenergic drugs should be avoided because of central nervous system toxicity.
It is rapidly bactericidal against S. Creatinine kinase levels should be monitored during therapy because there have been reports of muscle toxicity. Daptomycin only is available for intravenous administration, and the recommended dosage is 4 mg per kg over 30 minutes by intravenous infusion in 0. If the infection site is superficial, it may be reasonable to treat it with one of these agents. On the basis of minimal inhibitory concentration testing, community-acquired MRSA may be reported by the laboratory as susceptible to clindamycin and resistant to erythromycin.
In these cases, clindamycin may have inducible resistance that could emerge on therapy, so the laboratory can perform a double-disc diffusion test to check for inducible resistance and determine true susceptibility.
Management depends on extent of involvement. Wound care and drainage may be all that is necessary in small localized lesions. Localized impetigo may be treated topically with mupirocin Bactroban. Systemic antibiotics are used for cellulitis or in the presence of systemic symptoms.
Short courses i. Larger carbuncles or localized abscesses require incision and drainage. Because of the increasing concern of community-acquired MRSA, purulent lesions that require systemic therapy should be cultured so that antimicrobial susceptibility testing can be performed, and initial empiric treatment should consider the local prevalence of community-acquired MRSA.
Toxic shock syndrome manifests as fever, hypotension, a macular rash that later desquamates, and multiple organ dysfunction. Management includes removal of the focus of S. Management of staphylococcal scalded skin syndrome often requires intravenous antibiotics and potentially drainage of lesions, which are the basis of the infection with the toxin-producing strains. About 12 percent of patients with S. Transthoracic echocardiography helps secure the diagnosis of infective endocarditis and predict serious intracardiac complications.
Consultation with an infectious diseases sub-specialist may be beneficial. Algorithm for the management of Staphylococcus aureus bacteremia. Guidelines from the Infectious Diseases Society of America 20 recommend removal of non-tunneled central venous catheters associated with S. A tunneled i. Transesophageal echocardiography is recommended in the evaluation of catheter-related bloodstream infections. In the absence of endocarditis, septic phlebitis, or deep-seated infection, 14 days of systemic antimicrobial therapy is recommended.
A beta-lactam i. Treatment for S. In children, hematogenous spread often causes long bone osteomyelitis. Infected hardware generally requires removal, which may be delayed with use of oral antimicrobials until stability is ensured if there is bone nonunion. Although there is limited evidence regarding treatment, it usually is managed using drainage combined with a four-week course of antimicrobials.
During the last two weeks, antimicrobials sometimes are given orally to patients without bacteremia. Prosthetic joint infections are difficult to eradicate with the foreign material in place and usually require removal of the prosthesis followed by antibiotics for four to six weeks to treat the infection. Limited data indicate that early-onset infected joint prostheses may be treated with early debridement and prolonged courses of a quinolone plus rifampin Rifadin without prosthesis removal.
Empyema is caused by extension of local pneumonia. Therapy includes chest-tube drainage, and thorascopic or open drainage occasionally is required. Eighty-four percent of patients with postoperative S. Surgical or radiographic drainage usually is required, but some small abscesses in patients without neurologic deficits have responded to medical therapy. Contact precautions recommended by the Centers for Disease Control and Prevention for hospitalized patients with MRSA include use of a private room, wearing gloves on entering the room, wearing a gown if contact with the patient or items in the room is anticipated, and handwashing on removal of the gloves.
Adherence to the guidelines has been suboptimal, and hand-washing in particular is inadequate. About 5 percent of hospitalized patients are colonized with MRSA.
Advocates have suggested that more active surveillance using preemptive isolation and screening of patients, with stricter adherence to contact precautions and handwashing, may be more successful. Topical mupirocin is effective in reducing nasal colonization of S. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He also is vice chair for educational affairs in the Department of Medicine and section chief of infectious diseases at Truman Medical Center, Kansas City, Mo.
BOYD, M. She completed her medical degree and an internal medicine residency at UMKC. Address correspondence to David M.
0コメント