Management of Post-Operative Abdominal MRSA Wound Infections
Introduction to Treatment
- The Infectious Diseases Society of America recommends treating post-operative abdominal wound infections with confirmed MRSA using trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets (160mg/800mg) orally twice daily for 7-14 days, combined with surgical debridement and drainage 1, 2, 3
Surgical Management
- Suture removal plus incision and drainage must be performed as the primary intervention for any surgical site infection before or concurrent with antibiotic therapy, as recommended by the Infectious Diseases Society of America 3
- The American College of Surgeons suggests that surgical debridement is the mainstay of therapy and should be performed whenever feasible, as antibiotics alone are insufficient for purulent collections 4
Antibiotic Therapy
- The standard dose of TMP-SMX is 160mg/800mg (1 double-strength tablet) twice daily, which is the recommended starting dose for most patients with MRSA skin and soft tissue infections, according to the Infectious Diseases Society of America 2
- For abdominal/perineal surgical site infections, the Infectious Diseases Society of America recommends adding metronidazole 500mg every 8 hours to cover anaerobic organisms, or using a broader regimen 3
Treatment Duration and Assessment
- The Infectious Diseases Society of America recommends 7-14 days of therapy for surgical site infections with systemic signs, and reassessing clinically within 48-72 hours to ensure appropriate response to therapy 3
- If MRSA rate is high in the institution (>10-15%), the Infectious Diseases Society of America recommends empiric MRSA coverage with TMP-SMX or vancomycin while awaiting culture results 1, 3
Special Considerations
- The Infectious Diseases Society of America advises against using TMP-SMX as monotherapy for polymicrobial abdominal wound infections without anaerobic coverage, as this leads to treatment failure 3, 6
- For severe infections with systemic toxicity or sepsis, the Infectious Diseases Society of America recommends hospitalizing and using IV vancomycin 15-20 mg/kg every 8-12 hours plus piperacillin-tazobactam or a carbapenem 3, 6