Management of High-Risk MRSA Patients

Identification and Screening

Hospitals should identify patients at high risk for MRSA carriage upon admission, according to the Clinical Microbiology and Infection guidelines 1
Active MRSA surveillance cultures should be performed on high-risk patients to rapidly identify the MRSA reservoir, particularly in intensive care units, as recommended by the Clinical Microbiology and Infection guidelines 1
Screening is especially recommended before high-risk operations such as cardiothoracic and orthopedic surgery, based on the Clinical Microbiology and Infection guidelines 3

MRSA-colonized patients should be placed in single rooms or isolation wards, as stated in the Clinical Microbiology and Infection guidelines 1
Healthcare workers must wear gowns and gloves when caring for MRSA-colonized patients, according to the Clinical Microbiology and Infection guidelines 1

Intranasal mupirocin ointment twice daily for 5-10 days is recommended for nasal decolonization, based on the Clinical Infectious Diseases guidelines 4, 5
Chlorhexidine body wash or dilute bleach baths for 5-14 days are recommended for body decolonization, according to the Clinical Infectious Diseases guidelines 4, 5

For outpatient treatment of purulent skin and soft tissue infections, incision and drainage plus oral antibiotics such as clindamycin, trimethoprim-sulfamethoxazole, doxycycline, or linezolid are recommended, based on the Clinical Infectious Diseases guidelines 4, 6
For hospitalized patients with complicated skin and soft tissue infections, vancomycin, linezolid, daptomycin, or telavancin are recommended, according to the Clinical Infectious Diseases guidelines 4, 6
For uncomplicated MRSA bacteremia, vancomycin or daptomycin for at least 2 weeks are recommended, based on the Clinical Infectious Diseases guidelines 4, 5

For MRSA carriers undergoing cardiothoracic or orthopedic surgery, decolonization with intranasal mupirocin with or without chlorhexidine bath is recommended, according to the Clinical Microbiology and Infection guidelines 3

Focus cleaning on high-touch surfaces using appropriate cleaners or detergents, as stated in the Clinical Infectious Diseases guidelines 4
Educate patients and household contacts on maintaining good personal hygiene, based on the Clinical Infectious Diseases guidelines 4

Monitor mortality and morbidity associated with MRSA infections, as recommended by the Clinical Microbiology and Infection guidelines 1
Perform follow-up cultures to document clearance of bacteremia in infected patients, according to the Clinical Infectious Diseases guidelines 4

In pediatric patients, IV vancomycin is the primary treatment for serious MRSA infections, based on the Clinical Infectious Diseases guidelines 4, 6
For stable pediatric patients without ongoing bacteremia, clindamycin can be used if resistance rates are low, according to the Clinical Infectious Diseases guidelines 4, 6