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Methicillin-Resistant Staphylococcus aureus (MRSA) Information for Clinicians

General Information

  • Though once found almost exclusively in healthcare settings, strains of Staphylococcus aureus resistant to beta-lactam antibiotics (MRSA) are increasingly common as a cause of skin and soft tissue infections in patients who have no previous contact with healthcare. These strains are sometimes referred to as “community-associated MRSA”.

Clinical Features

  • MRSA infections often begin as skin or soft tissue lesions such as a boil or abscess and/or cellulitis.
  • Patients frequently report a lesion that looks to them like a “spider bite.”
  • Other more severe manifestations such as bloodstream infections or pneumonia are less common.


  • Obtain material for culture from skin lesions such as swab of pus or drainage.
  • Use microbiologic culture results to guide appropriate antibiotic selection.


  • Mild (afebrile, looks healthy) to Moderate (febrile, appears ill) Skin Infections
    • First-line treatment for mild abscesses is incision and drainage.
    • If antibiotic treatment is clinically indicated, it should be guided by the susceptibility profile of the organism.
      • If MRSA, avoid beta-lactam antibiotics (e.g., cephalexin).
      • Most MRSA in community settings have been susceptible to trimethoprim-sulfamethoxazole and doxycycline. Clindamycin is also an option, but some isolates that appear susceptible to clindamycin have inducible resistance. Clindamycin susceptibility should be confirmed with a “D-test”.
  • Severe Infection (e.g., appears toxic, vital signs unstable, sepsis-syndrome)
    • Intravenous therapy for MRSA is preferred in these cases. Vancomycin remains a first-line therapy for MRSA.
    • Final therapy based on results of culture and susceptibility testing.
    • Consult with infectious disease and critical care specialist.

Infection Control Recommendations

  • Use standard precautions
    • Perform hand hygiene (handwashing or using alcohol hand gel)
      • After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn.
      • Between patients.
      • When moving from a contaminated body site to a clean site on the same patient.
    • Wear gloves when managing wounds/
    • Wear gown, and mask/eye protection or face shield for procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.
    • Clean surfaces of exam rooms with commercial disinfectant or a 1:100 solution of diluted bleach (1 tablespoon bleach in 1 quart water).

Prevention Messages for Patients

  • Keep wounds and lesions covered with clean, dry bandages.
  • Wash hands or use alcohol hand gels after touching infected skin or bandages.
  • Avoid sharing personal items (e.g., towels, washcloths, razors).
  • Be on the lookout for similar infections in family members and/or close contacts.
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