Makindo Medical Notes

Up to 33% of the general population at any one time are colonised with Staphylococcus aureus (including MRSA) on areas of their body, such as the nose, skin, axilla, and groin.

About

• MRSA (methicillin-resistant Staphylococcus aureus) is a type of staph bacteria resistant to certain antibiotics and may cause skin and other infections.
• MRSA is generally not a risk to healthy people but poses a greater risk in healthcare environments.
• Healthcare workers can acquire MRSA through their work, though colonization is usually temporary.

Aetiology

• MRSA is resistant to flucloxacillin and may also be resistant to a broader range of antibiotics, complicating treatment options.

Patients at Risk

• Individuals with underlying illnesses
• Older adults, especially those with chronic conditions
• Severely ill patients, including those in intensive care units
• Patients with open wounds or those who have had major surgery
• Patients with invasive devices, such as urinary catheters

Suppression Management

• Body and Hair Treatment: Use an antibacterial solution (e.g., Octenisan, Hibiscrub, or Prontoderm Foam) daily for 5 days, following the manufacturer’s instructions. Hibiscrub is typically not recommended, so Octenisan or Prontoderm Foam are preferred.
• Nasal Treatment: Apply nasal Mupirocin 2% ointment (e.g., Bactroban nasal) three times daily for 5 days. For patients resistant to Mupirocin, use Naseptin nasal ointment four times daily for 10 days, as per manufacturer instructions.

Acute Management

• For patients known to be MRSA-positive or with MRSA risk factors, replace amoxicillin or flucloxacillin with IV Teicoplanin 400 mg (600 mg if the patient is over 100 kg).
• For MRSA sepsis, consider adding IV Vancomycin 1 g BD, administered over 100 minutes, assuming normal renal function.