Methicillin-Resistant Staphylococcus Aureus

Where do you find MRSA?

• Anterior nares
• Axilla, groin, perineum, rectum
• Dermatic skin, skin ulcers
• I.V. sites
• Indwelling catheters
• Tracheostomy tubes
• Feeding tubes

Antibiotic Resistance Profiles of MRSA:1

• All B-lactam antibiotics
• 94% resistant to clindamycin and erythomycin
• 89% resistant to ciprofloxacin
• 56% resistant to trimethoprimsulfamethoxazole
• 33% resistant to tetracycline
• 3% resistant to rifampin
• 3% resistant to fusidic acid
• 2% resistant to mupirocin

Antibiotic resistance varies from region to region in Canada

Suggestions for office practice involving MRSA patients:

• Hand hygiene
• When dealing with open wound:

- Gloves, Mask, Gown

- Contact isolation

- Barrier precautions

• Book MRSA patients at the end of the clinic day
• Educate patient about MRSA at home
• Educate office staff about reducing MRSA spread

Practical Points in Wound Care:

• Open wounds always contain bacteria
• Don’t try to eliminate bacteria from a wound
• Don’t try to decolonize the nares, if there is an open wound
• Don’t use oral antibiotics to “treat” wound colonization or wound contamination
• Don’t try to prevent wound infection with antibiotics
• Discontinue antibiotics when symptoms and signs of infection improve
• Do not let the presence of MRSA affect your decision about the diagnosis of infection

MRSA Treatment Flowchart

1 Andrew E. Simor, Marianna Ofner-Agostini, Elizabeth Bryce, Karen Green, Allison McGeer, Michael Mulvey, and Shirley Paton. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. Can. Med. Assoc. J. Jul 2001;165:21-26.

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