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

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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