Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children

Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children
Catherine Liu1, Arnold Bayer3,5, Sara E. Cosgrove6, Robert S. Daum7, Scott K. Fridkin8, Rachel J. Gorwitz9, Sheldon L. Kaplan10, Adolf W. Karchmer11, Donald P. Levine12, Barbara E. Murray14, Michael J. Rybak12,13, David A. Talan4,5, and Henry F. Chambers1,2

+ Author Affiliations
1Department of Medicine, Division of Infectious Diseases, University of California-San Francisco, San Francisco, California
2Division of Infectious Diseases, San Francisco General Hospital, San Francisco, CA
3Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA
4Divisions of Emergency Medicine and Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA
5Department of Medicine, David Geffen School of Medicine at University of California- Los Angeles
6Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland
7Department of Pediatrics, Section of Infectious Diseases, University of Chicago, Chicago, Illinois
8Division of Healthcare Quality Promotion, Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
9Division of Healthcare Quality Promotion, Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
10Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
11Division of Infectious Diseases, Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, Massachusetts
12 Department of Medicine, Division of Infectious Diseases, Wayne State University, Detroit Receiving Hospital and University Health Center, Detroit, Michigan
13Deparment of Pharmacy Practice, Wayne State University, Detroit Michigan
14Division of Infectious Diseases and Center for the Study of Emerging and Re-emerging Pathogens, University of Texas Medical School, Houston, Texas

Correspondence: Catherine Liu, MD, Dept of Medicine, Div of Infectious Diseases, University of California–San Francisco, San Francisco, California, 94102 (catherine.liu@ucsf.edu).

Abstract
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.


EXECUTIVE SUMMARY
MRSA is a significant cause of both health care–associated and community-associated infections. This document constitutes the first guidelines of the IDSA on the treatment of MRSA infections. The primary objective of these guidelines is to provide recommendations on the management of some of the most common clinical syndromes encountered by adult and pediatric clinicians who care for patients with MRSA infections. The guidelines address issues related to the use of vancomycin therapy in the treatment of MRSA infections, including dosing and monitoring, current limitations of susceptibility testing, and the use of alternate therapies for those patients with vancomycin treatment failure and infection due to strains with reduced susceptibility to vancomycin. The guidelines do not discuss active surveillance testing or other MRSA infection–prevention strategies in health care settings, which are addressed in previously published guidelines [1, 2]. Each section of the guidelines begins with a specific clinical question and is followed by numbered recommendations and a summary of the most-relevant evidence in support of the recommendations. Areas of controversy in which data are limited or conflicting and where additional research is needed are indicated throughout the document and are highlighted in the Research Gaps section. The key recommendations are summarized below in the Executive Summary; each topic is discussed in greater detail within the main body of the guidelines.
Please note that specific recommendations on vancomycin dosing and monitoring are not discussed in the sections for each clinical syndrome but are collectively addressed in detail in Section VIII.

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Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children