IDSA issues guidelines for treating MRSA infections

Jan 5, 2011 (CIDRAP News) – Saying current treatment practices vary widely, the Infectious Diseases Society of America (IDSA) today released lengthy guidelines for treating methicillin-resistant Staphylococcus aureus (MRSA) infections, which the group said now account for most of the skin infections that send people to emergency rooms.

The guidelines cover MRSA skin infections and the less common but more serious invasive infections, such as pneumonia and infections of the blood, heart, bones, joints, and central nervous system.

The IDSA released the guidelines online today and will also publish them in the Feb 1 issue of Clinical Infectious Diseases. In the journal format the guidelines run to about 28 pages, not counting references. They were prepared by a panel of 13 experts.

"MRSA has become a huge public health problem and physicians often struggle with how to treat it," Catherine Liu, MD, lead author of the guidelines and assistant clinical professor in infectious diseases at the University of California, San Francisco, said in an IDSA press release.

"The guidelines establish a framework to help physicians determine how to evaluate and treat uncomplicated as well as invasive infections," Liu said. "It's designed to be a living document, meaning the recommendations will evolve as new information and antibiotics become available."

MRSA has been a concern in hospitals for decades and in the last 15 years has become a serious problem among healthy people in the community as well, the IDSA said. It said MRSA now accounts for about 60% of skin infections seen in emergency rooms. The guidelines note that many of these skin infections can be treated without antibiotics.

Community-associated MRSA often spreads in locker rooms, dormitories, jails, homes, and day care centers, usually through direct contact or via objects such as towels, razors, and sports equipment, the IDSA said. It typically causes painful red bumps about the size of a pencil eraser or golf ball, which can appear anywhere but most often show up at the site of a cut or abrasion or in areas covered by hair, the group said.

The number of invasive MRSA infections in the United States was estimated at 94,360 in 2005, and about 18,000 people died, according to a study published in the Journal of the American Medical Association, the IDSA said. About 1 in 7 of these infections was classified as community-associated.

The guidelines cover treatment of skin and soft-tissue infections, recurrent skin infections, invasive infections, and infections in newborns. Included are recommendations on the use of intravenous vancomycin and other antibiotics.

The guidelines, which were endorsed by several other professional societies, "are not intended to take the place of a doctor's judgment, but rather support the decision-making process, which must be individualized according to each patient's circumstances," the IDSA said.

See also:

Jan 5 IDSA press release

Full text of guidelines

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