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Diseases

MRSA

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • MRSA is an important cause of infection in both healthy people in the community and in patients in healthcare institutions.

  • It is important to distinguish MRSA colonization from infection.

  • Healthcare-associated MRSA infections and community-associated MRSA infections exhibit important differences in antibiotic susceptibility.

  • Community-associated MRSA most commonly results in skin and soft-tissue infections and therapy can often be with oral antibiotics.

  • Healthcare-associated MRSA infections usually require treatment with intravenous antibiotics.

A common ulcerative skin lesion secondary to MRSA on a patient's arm
A common ulcerative skin lesion secondary to MRSA on a patient's arm
Public Health Image Library, CDC website

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • A common ulcerative skin lesion secondary to MRSA on a patient's arm

            A common ulcerative skin lesion secondary to MRSA on a patient's arm

          • Cutaneous abscess caused by MRSA

            Cutaneous abscess caused by MRSA

          • Cutaneous abscess on the foot post-packing, caused by MRSA (side view)

            Cutaneous abscess on the foot post-packing, caused by MRSA (side view)

          • Cutaneous abscess on the foot post-packing, caused by MRSA (front view)

            Cutaneous abscess on the foot post-packing, caused by MRSA (front view)

          • BMJ Rapid Recommendations: Antibiotics after incision and drainage for uncomplicated skin abscesses

            BMJ Rapid Recommendations: Antibiotics after incision and drainage for uncomplicated skin abscesses

          • BMJ Rapid Recommendations: Antibiotics after incision and drainage for uncomplicated skin abscesses

            BMJ Rapid Recommendations: Antibiotics after incision and drainage for uncomplicated skin abscesses

          • BMJ Rapid Recommendations: antibiotics after incision and drainage for uncomplicated skin abscesses

            BMJ Rapid Recommendations: antibiotics after incision and drainage for uncomplicated skin abscesses

          Citations

            Key Articles

            • Gorwitz RJ. A review of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J. 2008 Jan;27(1):1-7.[Abstract]

            • Nathwani D, Morgan M, Masterton RG, et al. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother. 2008 May;61(5):976-94.[Abstract][Full Text]

            • Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.[Abstract][Full Text]

            • Brown NM, Goodman AL, Horner C, et al. Treatment of methicillin-resistant Staphylococcus aureus (MRSA): updated guidelines from the UK. JAC Antimicrob Resist. 2021 Mar;3(1):dlaa114.[Abstract][Full Text]

            Other Online Resources

            • CDC: Methicillin-resistant Staphylococcus aureus (MRSA)
            • BMJ Rapid Recommendations: antibiotics after incision and drainage for uncomplicated skin abscesses
            • MAGICapp: recommendations, evidence summaries and consultation decision aids

            Referenced Articles

            • 1. Babel BS, Decker CF. Microbiology and laboratory diagnosis of MRSA. Dis Mon. 2008 Dec;54(12):769-73.[Abstract]

            • 2. Centers for Disease Control and Prevention. Laboratory detection of oxacillin/methicillin-resistant Staphylococcus aureus. May 2019 [internet publication].[Full Text]

            • 3. Gorwitz RJ. A review of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J. 2008 Jan;27(1):1-7.[Abstract]

            • 4. Crum NF, Lee RU, Thornton SA, et al. Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med. 2006 Nov;119(11):943-51.[Abstract]

            • 5. Styers D, Sheehan DJ, Hogan P, et al. Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann Clin Microbiol Antimicrob. 2006 Feb 9;5:2.[Abstract][Full Text]

            • 6. Zinn CS, Westh H, Rosdahl VT; Sarisa Study Group. An international multicenter study of antimicrobial resistance and typing of hospital Staphylococcus aureus isolates from 21 laboratories in 19 countries or states. Microb Drug Resist. 2004 Summer;10(2):160-8.[Abstract]

            • 7. Que YA, Moreillon P. Staphylococcus aureus (including Staphylococcal toxic shock syndrome). In: Bennett JE, Dolin R, Blaser MJ, ed. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th ed. Philadelphia, PA: Elsevier; 2020: 2393-431.

            • 8. Kourtis AP, Hatfield K, Baggs J, et al. Vital signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections - United States. MMWR Morb Mortal Wkly Rep. 2019 Mar 8;68(9):214-9.[Abstract][Full Text]

            • 9. Edgeworth JD, Batra R, Wulff J, et al. Reductions in methicillin-resistant staphylococcus aureus, clostridium difficile infection and intensive care unit-acquired bloodstream infection across the United Kingdom following implementation of a national infection control campaign. Clin Infect Dis. 2020 Jun 10;70(12):2530-40.[Abstract][Full Text]

            • 10. World Health Organization. ​Antimicrobial resistance surveillance in Europe 2023-2021 data. Apr 2023 [internet publication].[Full Text]

            • 11. Gagliotti C, Högberg LD, Billström H, et al. Staphylococcus aureus bloodstream infections: diverging trends of methicillin-resistant and methicillin-susceptible isolates, EU/EEA, 2005 to 2018. Euro Surveill. 2021 Nov;26(46).[Abstract][Full Text]

            • 12. Lakhundi S, Zhang K. Methicillin-resistant staphylococcus aureus: molecular characterization, evolution, and epidemiology. Clin Microbiol Rev. 2018 Oct;31(4).[Abstract][Full Text]

            • 13. Jackson KA, Bohm MK, Brooks JT, et al. Invasive methicillin-resistant Staphylococcus aureus infections among persons who inject drugs - six sites, 2005-2016. MMWR Morb Mortal Wkly Rep. 2018 Jun 8;67(22):625-8.[Abstract][Full Text]

            • 14. Gorwitz RJ, Kruszon-Moran D, McAllister SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis. 2008 May 1;197(9):1226-34.[Abstract][Full Text]

            • 15. Elston DM. Community-acquired methicillin-resistant Staphylococcus aureus. J Am Acad Dermatol. 2007 Jan;56(1):1-16.[Abstract]

            • 16. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003 Dec 10;290(22):2976-84.[Abstract][Full Text]

            • 17. Boyle-Vavra S, Daum RS. Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton-Valentine leukocidin. Lab Invest. 2007 Jan;87(1):3-9.[Abstract][Full Text]

            • 18. Shorr AF. Epidemiology and economic impact of meticillin-resistant Staphylococcus aureus. Pharmacoeconomics. 2007;25(9):751-68.[Abstract]

            • 19. Salgado CD, Faar BM, Calfee DP. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003 Jan 15;36(2):131-9.[Abstract][Full Text]

            • 20. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005 Apr 7;352(14):1436-44.[Abstract][Full Text]

            • 21. Safdar N, Bradley EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med. 2008 Apr;121(4):310-5.[Abstract]

            • 22. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.[Abstract][Full Text]

            • 23. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.[Abstract][Full Text]

            • 24. Tristan A, Ferry T, Durand G, et al. Virulence determinants in community and hospital meticillin-resistant Staphylococcus aureus. J Hosp Infect. 2007 Jun;65(suppl 2):105-9.[Abstract]

            • 25. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247.[Abstract][Full Text]

            • 26. Academy of Medical Royal Colleges. Statement on the initial antimicrobial treatment of sepsis. May 2022 [internet publication].[Full Text]

            • 27. Harabarth S, Fankhauser C, Schrenzel J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients.JAMA. 2008 Mar 12;299(10):1149-57.[Abstract][Full Text]

            • 28. Gould IM. Costs of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and its control. Int J Antimicrob Agents. 2006 Nov;28(5):379-84.[Abstract]

            • 29. Tacconelli E, De Angelis G, de Waure C, et al. Rapid screening tests for methicillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis. Lancet Infect Dis. 2009 Sep;9(9):546-54.[Abstract]

            • 30. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):285-92.[Abstract][Full Text]

            • 31. Daum RS, Miller LG, Immergluck L, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med. 2017 Jun 29;376(26):2545-55.[Abstract][Full Text]

            • 32. Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med. 2016 Mar 3;374(9):823-32.[Abstract][Full Text]

            • 33. Nathwani D, Morgan M, Masterton RG, et al. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother. 2008 May;61(5):976-94.[Abstract][Full Text]

            • 34. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.[Abstract][Full Text]

            • 35. Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007 Jul 26;357(4):380-90.[Abstract]

            • 36. US Food and Drug Administration. FDA drug safety communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. May 2016 [internet publication].[Full Text]

            • 37. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. Mar 2019 [internet publication].[Full Text]

            • 38. US Food and Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication].[Full Text]

            • 39. US Food and Drug Administration. FDA drug safety communication: FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication].[Full Text]

            • 40. Brown NM, Goodman AL, Horner C, et al. Treatment of methicillin-resistant Staphylococcus aureus (MRSA): updated guidelines from the UK. JAC Antimicrob Resist. 2021 Mar;3(1):dlaa114.[Abstract][Full Text]

            • 41. Rodvold KA, McConeghy KW. Methicillin-resistant Staphylococcus aureus therapy: past, present, and future. Clin Infect Dis. 2014 Jan;58 (suppl 1):S20-7.[Abstract][Full Text]

            • 42. Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014 Oct 1;312(13):1330-41.[Abstract][Full Text]

            • 43. Paul M, Bishara J, Yahav D, et al. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ. 2015 May 14;350:h2219.[Abstract][Full Text]

            • 44. Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012 Mar 1;54(5):621-9.[Abstract][Full Text]

            • 45. Writing Committee Members., Otto CM, Nishimura RA, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):e25-e197.[Abstract][Full Text]

            • 46. Ammerlaan HS, Kluytmans JA, Wertheim HF, et al. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis. 2009 Apr 1;48(7):922-30.[Abstract][Full Text]

            • 47. McConeghy KW, Mikolich DJ, LaPlante KL, et al. Agents for the decolonization of methicillin-resistant Staphylococcus aureus. Pharmacotherapy. 2009 Mar;29(3):263-80.[Abstract]

            • 48. van Rijen M, Bonten M, Wenzel R, et al. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006216.[Abstract][Full Text]

            • 49. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013 Jun 13;368(24):2255-65.[Abstract][Full Text]

            • 50. Vermandere M, Aertgeerts B, Agoritsas T, et al. Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline. BMJ. 2018 Feb 6;360:k243.[Full Text]

            • 51. Drew RH. Emerging options for treatment of invasive, multidrug-resistant Staphylococcus aureus infections. Pharmacotherapy. 2007 Feb;27(2):227-49.[Abstract]

            • 52. Anguita-Alonso P, Hanssen AD, Patel R. Prosthetic joint infection. Expert Rev Anti Infect Ther. 2005 Oct;3(5):797-804.[Abstract]

            • 53. Esposito S, Leone S. Prosthetic joint infections: microbiology, diagnosis, management and prevention. Int J Antimicrob Agents. 2008 Oct;32(4):287-93.[Abstract]

            • 54. Scott RW, Tew GN. Mimics of host defense proteins; strategies for translation to therapeutic applications. Curr Top Med Chem. 2017;17(5):576-89.[Abstract]

            • 55. Kisgen J, Whitney D. Ceftobiprole, a broad-spectrum cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA). P T. 2008 Nov;33(11):631-41.[Abstract][Full Text]

            • 56. Micek ST. Alternatives to vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2007 Sep 15;45(suppl 3):S184-90.[Abstract][Full Text]

            • 57. Falagas ME, Roussos N, Gkegkes ID, et al. Fosfomycin for the treatment of infections caused by Gram-positive cocci with advanced antimicrobial drug resistance: a review of microbiological, animal and clinical studies. Expert Opin Investig Drugs. 2009 Jul;18(7):921-44.[Abstract]

            • 58. Popovich KJ, Aureden K, Ham DC, et al. SHEA/IDSA/APIC Practice recommendation: strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023 Jun 29;44(7):1-29.[Abstract][Full Text]

            • 59. Calderwood MS, Anderson DJ, Bratzler DW, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2023 May;44(5):695-720.[Abstract][Full Text]

            • 60. Banach DB, Bearman G, Barnden M, et al. Duration of contact precautions for acute-care settings. Infect Control Hosp Epidemiol. 2018 Feb;39(2):127-44.[Abstract]

            • 61. Moore DL; Canadian Paediatric Society. Infection prevention and control in paediatric office settings. Paediatr Child Health. 2018 Dec;23(8):547-8.[Abstract][Full Text]

            • 62. Irvine J; Canadian Paediatric Society. Community-associated methicillin-resistant Staphylococcus aureus in indigenous communities in Canada. Paediatr Child Health. 2012 Aug;17(7):395-8.[Abstract][Full Text]

            • 63. Siegel JD, Rhinehart E, Jackson M, et al. Management of multidrug-resistant organisms in healthcare settings, 2006. Am J Infect Control. 2007 Dec;35(10 suppl 2):S165-93.[Abstract]

            • 64. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45, quiz CE1-4.[Abstract][Full Text]

            • 65. Sartelli M, Guirao X, Hardcastle TC, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018 Dec 14;13:58.[Abstract][Full Text]

            • 66. Coia JE, Wilson JA, Bak A, et al. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2021 Dec;118S:S1-39.[Full Text]

            • 67. Wallace MR, Mascola JR, Oldfield EC 3rd. Red man syndrome: incidence, etiology, and prophylaxis. J Infect Dis. 1991 Dec;164(6):1180-5.[Abstract]

            • 68. Mork RL, Hogan PG, Muenks CE, et al. Longitudinal, strain-specific Staphylococcus aureus introduction and transmission events in households of children with community-associated meticillin-resistant S aureus skin and soft tissue infection: a prospective cohort study. Lancet Infect Dis. 2020 Feb;20(2):188-98.[Abstract]

            • 69. Sroka S, Gastmeier P, Meyer E. Impact of alcohol hand-rub use on meticillin-resistant Staphylococcus aureus: an analysis of the literature. J Hosp Infect. 2010 Mar;74(3):204-11.[Abstract]

            • 70. Huang SS, Singh R, McKinnell JA, et al. Decolonization to reduce postdischarge infection risk among MRSA carriers. N Engl J Med. 2019 Feb 14;380(7):638-50.[Abstract][Full Text]

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