Spectrum: Local Antimicrobial Stewardship, for UCLA Health

Community-Acquired MRSA

Note

In the absence of necrotizing pneumonia with cavitation, empiric coverage for CA-MRSA can be deferred until sputum and blood culture results return given their high diagnostic yield for CA-MRSA.

Necrotizing pneumonia with cavitation in absence of risk factors for cavitation listed below is concerning for CA-MRSA pneumonia, particularly if associated with a preceding or concomitant influenza-like illness.

ID Consult is strongly recommended

Risk Factors For Cavitation

  • Prolonged hospital or long-term care facility stay (>5 days)

  •  Structural disease of lung (e.g. CF, Bronchiectasis)

  • Steroid Rx (>10mg prednisone/d or equivalent)

  • Broad-Spectrum antibiotics for >7 days in the past 1 month

  • AIDS, especially CD4 < 50/mL

  •  Neutropenia (ANC < 500/dL)

Empiric Treatment

Vancomycin (Dosing per pharmacy)

OR

Linezolid 600mg IV/PO q12h*

*Use of linezolid monotherapy for MRSA bacteremia, even if associated with a pulmonary source, is not recommended.

Treatment Note

Daptomycin does not have activity for pulmonary infections