Spectrum: Local Antimicrobial Stewardship, for Island Health

IAI MRSA

MRSA in IAI

MRSA does not usually live in the biliary tree or the gastrointestinal (GI) tract

MRSA is not routinely implicated in community-acquired IAI, even in colonized patients

The risk of a patient acquiring new MRSA while associating with an Island Health facility is ~ 1 in 1500

MRSA can become involved in IAI if the patient is/becomes colonized and there is transmission from the skin or anterior nares

Examples:

  • recent IA surgery

  • percutanious procedures

  • presence of drains

  • open abdomen

MRSA should not be ignored if isolated in these scenarios

Situations when anti-MRSA therapy should be considered

  • empiric treatment of health-care associated infections in critically ill patients, especially in those without source control or known colonization

  • treatment failure and significant antibiotic exposure

  • MRSA isolated from IA specimen

  • post-operative wound infection with MRSA

General Pathogen Information

Methicillin-Resistant Staphylococcus Aureus

Treatment of MRSA in IAI

Vancomycin loading dose 25 mg/kg IV then maintenance dose of 15 mg/kg (refer to clinical pharmacist to adjust the dose)

Vancomycin Nomogram High-Trough

Oral Step-Down

Highly individualized depending on clinical scenario and susceptibilities

Potential Oral Options:
Doxycycline
Sulfamethoxazole-Trimetoprom
Clindamycin
Linezolid