Community-Associated Staphylococcus aureus ... - SWACM

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# OF STRAINS TESTEDCEFAZOLIN/OXACILLINCLINDAMYCINERYTHROMYCINLINEZOLIDTETRACYCLINETMP-SMXVANCOMYCINManagement of SSTI in the Era ofCA-MRSA• Cutaneous abscess:– Incision and drainage (I&D) is the primarytreatment– For simple abscesses and boils, I&D aloneis likely to be adequate• Additional data are needed to furtherdefine the role of antibiotics, if any, in thissettingLiu C et al., Clin Infect Dis 2011; 52:285-292TMP-SMXIncision & DrainagePlacebo• No significant difference in cure rates betweenTMP-SMX and placebo• Antibiotic therapy may decrease new lesiondevelopmentDuong M, et al., Ann Emerg Med 2010; 55:401-407Schmitz G et al., Ann Emerg Med 2010; 56:283-287Conditions in which Antibiotics areRecommended after I&D• Severe or extensive disease– Involving multiple sites of infection• Rapid progression in presence of associated cellulitis• Signs and symptoms of systemic illness• Associated co-morbidities or immunosuppression– Diabetes mellitus, HIV/AIDS, neoplasm• Extremes of age• Abscess in an area difficult to drain– Face, hand, genitalia• Associated septic phlebitis• Lack of response to incision and drainage aloneLiu C et al., Clin Infect Dis 2011; 52:285-292SLCH S. aureus AntibiogramOutlineEmergency Dept. AbscessAntibiogram (2009-2010)Staphylococcus aureus 1712 23 91 15 100 97 99 100MRSA 1314 0 92 9 100 98 100 100MSSA 398 100 89 41 100 94 98 100Cumulative Antibiogram 2010Staphylococcus aureus 1970 43 78 31 100 97 99 100MRSA 1133 0 79 10 100 97 99 100MSSA 837 100 75 59 100 96 98 100• Historical perspective of Staphylococcus aureus• Emergence and epidemiology of communityassociatedmethicillin-resistant S. aureus (CA-MRSA)• Treatment of CA-MRSA infections• Prevention of recurrent diseaseData indicate percent susceptible for each antimicrobial tested. Data based on first isolate per patient.Courtesy of Carey-Ann Burnham, PhD6
Management of Recurrent SSTI• Emphasize personal hygiene andappropriate wound care– Regular bathing• Shower after exercise and any activity thatinvolves direct skin contact with others– Keep hands clean• Soap and water• Alcohol-based hand sanitizers– Avoid sharing personal hygiene items• Environmental hygiene measures– Cleaning high-touch surfaces that maycontact bare skin or uncovered infectionsLiu C et al., Clin Infect Dis 2011; 52:285-292Decolonization• S. aureus colonization is a risk factor for SSTI 1,2• Decolonization– The use of antimicrobial or antiseptic agents to suppressor eliminate S. aureus carriage 3– Traditionally used to prevent healthcare-associated MRSA(HA-MRSA) infections– Decolonization is frequently prescribed to patients incommunity settings to prevent recurrent SSTI(1) Fritz SA et al. J Infect 2009; 59:394-401(2) Ellis MW et al. Clin Infect Dis 2004; 39:971-9(3) Liu C et al. Clin Infect Dis 2011; 52:285-292Management of Recurrent SSTI• Decolonization may be considered in selected cases:– A patient develops a recurrent SSTI despite optimizingwound care and hygiene measures– Ongoing transmission is occurring among householdmembers or other close contacts despite optimizing woundcare and hygiene measuresDecolonization Regimens• Mupirocin– Inhibits bacterial isoleucyl-tRNAsynthetase• Protein synthesis inhibition• Chlorhexidine– Biguanide cationic bactericidal agent• Disrupts integrity of cell wall andmembranes• Causes coagulation of intracellular contents• Dilute Bleach (Sodium Hypochlorite)– S. aureus antimicrobial activity both invivo and in vitroLiu C et al., Clin Infect Dis 2011; 52:285-292Uncertainty SurroundingDecolonization• Do these measures actually eradicate theorganism?• Does decolonization prevent SSTI?• Who should perform decolonization?StL StaRSSt. LouisStaphylococcus aureusReduction StudyRandomized Controlled Trial EvaluatingDecolonization Regimens in Patients withCommunity-Associated Skin InfectionsColonized with Staphylococcus aureusFritz SA et al., Infect Control Hosp Epidemiol 2011;32:872-8807
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