24. Agents recommended for the carriage of MRSA

Please refer to the infection control policy available on the trust intranet.

Nasal carriage
Mupirocin (Bactroban) nasal ointment - to be used three times daily for 5 days.

Skin carriage
Triclosan 2% (Aquasept or Octenisan) aqueous solution
Or
Triclosan 2% (Oilatum plus) - to be used for skin cleansing for patients with dry skin

For further information please contact infection control on ext. 2632

Treatment of MRSA

Consider the following for patients from whom MRSA is cultured:

Choice of antibiotic

MRSA (methicillin resistant Staphylococcus aureus) is a bacteria that is resistant to penicillins and cephalosporins (e.g. flucloxacillin is not an appropriate choice for the treatment of MRSA). It is often associated with hospital-acquired infections and can cause infections such as skin and soft tissue infections, pneumonias and bacteraemias.

Vancomycin is often the initial antibiotic of choice if the infection is severe. Most epidemic MRSA-15 and -16 strains are resistant to quinolones.
 
Oral antibiotics are indicated for the treatment of superficial infections or as follow-up after an initial intravenous course. The choice of oral antibiotics must be guided by the sensitivity pattern and if necessary, discussed with a consultant microbiologist.

REFER TO FLOWCHART

Duration of therapy (approximate guide)
Consider severity, site of infection, speed of response to antibiotics, concomitant illnesses. The following is intended as a guideline only:
Mild chest infection - 7 days
Severe pneumonia - total 14 days
Bacteraemia - total 14 days following removal of source, e.g. central line
Superficial wound infection - 10 days.