全套MRSA指南__培训课件.pptVIP

Note: Oral antimicrobial therapy for active infection only, not decolonization (A-III) Oral agent plus rifampin (if susceptible) may be considered for decolonization if infections recur despite measures mentioned above Surveillance cultures following decolonization regimen not routinely recommended in absence of active infection (B-III) MRSA Guidelines: Recommendations for management of recurrent MRSA SSTIs (con’t) MRSA Guidelines: Adults with Infective Endocarditis, Prosthetic Valve Early evaluation for valve replacement surgery is also recommended (A-II) *Classification of the strength of recommendation and quality of evidence MRSA=methicillin-resistant Staphylococcus aureus Antibiotic therapy with vancomycin plus rifampin plus gentamicin is recommended (B-III) Summary of Antibiotic Regimen for Adults with MRSA Infective Endocarditis, Prosthetic valve Treatment Adult Dose Class* Vancomycin + gentamicin + rifampin 15-20 mg/kg/dose IV q8-12h x6 weeks1 mg/kg/dose IV q8h x2 weeks 300 mg PO/IV q8h x6 weeks B-III MRSA Guidelines: Adults with Bacteremia or Infective Endocarditis, Native Valve1 Recommended duration of therapy Uncomplicated bacteremia – at least 2 weeks Complicated bacteremia – 4-6 weeks Infective endocarditis, native valve – 6 weeks Summary of Antibiotic Options for Adults with MRSA Bacteremia or Infective Endocarditis, Native valve Treatment Adult Dose Class* Comments Vancomycin 15-20 mg/kg/dose IV q8-12h A-II The addition of gentamicin (A-II) or rifampin (A-I) to vancomycin is not recommended Daptomycin 6 mg/kg/dose IV QD A-I Some experts recommend higher dosages of 8-10 mg/kg/day IV QD (B-III) *Classification of the strength of recommendation and quality of evidence MRSA=methicillin-resistant Staphylococcus aureus 1. 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 Ja