Staphylococcal Infections Treatment & Management

Updated: Jun 12, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Treatment

Medical Care

Promptly start antimicrobial therapy when S aureus infection is documented or strongly suspected. Appropriate choices depend on local susceptibility patterns. [1] Initiation of subinhibitory concentrations of antibiotics may lead to increased production of PVL. [29] The Infectious Diseases Society of America (IDSA) has published detailed guidelines on the treatment of methicillin-resistant S aureus infections. [30]

Temporary intravascular devices should be promptly removed if infection is suspected. [2] Long-term intravascular devices should be removed if infection with S aureus is documented.

Multiple decolonization regimens have been used in patients with recurrent staphylococcal infection. Treatment with topical mupirocin, chlorhexidine gluconate washes, and oral rifampin plus doxycycline for 7 days eradicated methicillin-resistant S aureus (MRSA) colonization in hospitalized patients. [3] Household members should avoid sharing personal hygiene items; decolonization of all household members should be recommended to patients with recurrent SSTI or to patients with multiple household members who experience SSTI. [31]

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Surgical Care

Abscesses must be drained. Infections involving a prosthetic joint usually require removal of the prosthesis. Other infections involving a prosthetic device, such as a prosthetic heart valve or implanted intravascular device, may or may not require removal of the device.

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Consultations

Consultation with an infectious disease specialist should be obtained for all patients with S aureus bacteremia. Doing so results in improved adherence to IDSA guidelines, decreased in-hospital mortality, and earlier discharge. [32] Pharmacist intervention through vancomycin dosing has been shown to improve survival rates in a retrospective study of patients with MRSA bacteremia. [4]

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