Therapeutic target
- Rehabilitation or cure of the patient
Therapy recommendations
- Infections with oxacillin-susceptible S. aureus: penicillinase-resistant penicillins (e.g., flucloxacillin) as well as 1st-generation cephalosporins and inhibitor-protected penicillins (agents of choice)In generalizing infections, combined with an aminoglycoside; for duration of therapy, see “Additional Information”
- MRE (multidrug-resistant pathogens): isolation of the patient (single room; surgical mouthguard; work procedures according to infection control manual) [critics of isolated rooms point out that isolation units often increase bacteremia rates due to contamination of glove boxes → with the disposable gloves, the pathogens are passed on via intravenous injection].
- In complicated infections consil with microbiologist / infectiologist.
- Therapy for MRSA:
- Strain haMRSA (for “healthcare associated”): reserve antibiotics are linezolid and quinupristin/dalfopristin. Combination of cotrimoxazole and rifampicin or clindamycin and rifampicin.
- Strain caMRSA (“community-acquired”; these are MRSA occurring outside the hospital): Reserve antibiotic is linezolid. Smaller solitary furuncles should also receive systemic antibiotic treatment for caMRSA.
- Sanitation: For decolonization of haMRSA and caMRSA; duration of sanitation measures: 5 days.
- Nasal vestibules: 3 x daily mupirocin nasal ointment.
- Throat: gargle 3 x daily with 0.1% chlorhexidine solution or octenidine solution.
- Skin and hair: 1 x tgl: disinfection, ie showering or full body care including hair washing with suitable disinfecting wash lotion (eg Octenisan wash lotion).
- Wounds: 3 x daily octenidine, for smaller lesions (< 3 cm2) also mupirocin ointment.
- Surface disinfection of the shower / tub after each use.
- To prevent recolonization during sanitation:
- Daily change of bed linen, clothing and personal hygiene utensils (towels, washcloths).
- Personal items (eg, razors) are to be disinfected or replaced after use. Waiver of roll-on deodorant.
- Control of the success of sanitation for MRSA:
- First control smear after a treatment break of at least 48 hrs. (avoid false-negative results).
- In MRSA-negative smear (preliminary sanitation success): control smears after 3-6 and after 12 months.
- Other pharmacotherapy: see under the respective disease.
Further notes
- Ureidothiophene carboxylic acids, a novel class of compounds is effective against both HIV and methicillin-resistant Staphylococcus aureus (MRSA). However, extensive studies and development work are still required before clinical application becomes possible.
- A clinical checklist that assigns patients with Staphylococcus aureus bacteremia to different groups can shorten antibiotic therapy by several days, according to one study. According to this checklist, two categories are distinguished based on the duration of fever, blood culture results, and echocardiography findings (to rule out endocarditis):
- Single positive blood culture with coagulase-negative staphylococci without symptoms and without a focus of infection (e.g., catheter) → antibiotic therapy for a few days.
- Complicated Staphylococcus aureus infection with involvement of heart valves or metastatic foci of infection → antibiotic therapy for at least > 4 weeks.
as a result, this approach did not compromise patient safety; at the same time, for patients with uncomplicated bacteremia, the duration of therapy was reduced by almost 2 days; patients in the group with uncomplicated coagulase-negative staphylococci even had a reduced duration of therapy by 3 days.
