risk factors/features suggestive of community-aquired MRSA (CA-MRSA)
Last reviewed 01/2018
- community-associated MRSA
- if 'spider bite' lesions are present,
the possibility of CA-MRSA or Panton–Valentine leucocidin (PVL)-positive methicillin
sensitive Staphylococcal aureus (MSSA) infection should be considered and appropriate
investigation and management instituted
- typical of cutaneous CA-MRSA
infections
- spontaneous appearance of a raised tender red lesion, which may progress to develop a necrotic centre
- typical of cutaneous CA-MRSA
infections
- if there is a history of recurrent abscesses or household clusters of infection, the possibility of CA-MRSA or PVL-positive MSSA infection should be considered and appropriate investigation and management instituted
- if there has been a prior poor response to ß-lactam therapy, the possibility of CA-MRSA or PVL-positive MSSA infection should be considered and appropriate investigation and management instituted
- if there is a history of exposure to one or more antibiotics
in the past year, especially quinolones or macrolides, the possibility of CA-MRSA
infection should be considered and appropriate investigation and management instituted
- risk
factors for CA-MRSA include:
- children <2 years old
- athletes (mainly contact-sport participants)
- injection drug users
- men who have sex with men
- military personnel
- inmates of correctional facilities, residential homes or shelters
- vets, pet owners and pig farmers
- patients with post-flu-like illness and/or severe pneumonia
- patients with concurrent skin and soft tissue injury
- history of colonization or recent infection with CA-MRSA
- history of antibiotic consumption in the previous year, particularly quinolones or macrolides
- risk
factors for CA-MRSA include:
- cultures should be taken
from septic sites if:
- CA-MRSA is suspected because of the risk assessment based on clinical presentation, treatment factors and other risk factors
- there are recurrent furuncles or abscesses (two or more in 6 months)
- there is a history of spread in the family or to others, e.g. sporting contacts (the information may be available from the public health/infection control team)
- there is severe infection (extensive or progressive disease with evidence of systemic sepsis), the patient should be hospitalized and a skin/abscess culture and blood culture should be taken
- do not take cultures routinely from patients presenting with minor SSTIs and without a history of previous MRSA
- do not routinely aspirate material for culture from cellulitis in the absence of discharge or broken skin
- if 'spider bite' lesions are present,
the possibility of CA-MRSA or Panton–Valentine leucocidin (PVL)-positive methicillin
sensitive Staphylococcal aureus (MSSA) infection should be considered and appropriate
investigation and management instituted
Reference: