Early appropriate parenteral antimicrobial treatment of complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus.
BACKGROUND
Complicated skin and soft tissue infections (cSSTIs) are a major clinical problem, in part because of the increasing resistance of infecting bacteria to our current antibiotic therapies. Prompt appropriate treatment of infections in hospitalized patients reduces the mortality rate. Furthermore, appropriate and timely antibiotic therapy improves outcomes for cSSTIs caused by methicillin-resistant Staphylococcus aureus (MRSA). This review delineates factors to consider in the choice of initial antibiotic treatment for cSSTIs and describes the antimicrobial agents available or under clinical development for the treatment of cSSTIs caused by MRSA.


METHODS
Review of the pertinent literature and recommendations.


RESULTS
The choice of antimicrobial agent for empiric treatment of cSSTIs should be guided by the site and type of infection, the presence of an immunocompromised state or neutropenia, and risk factors for hospital-acquired MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) infection. Most CA-MRSA strains remain susceptible to ciprofloxacin, clindamycin, gentamicin, and trimethoprim/sulfamethoxazole, although resistance to clindamycin can emerge during treatment. Of the agents available for the treatment of HA-MRSA cSSTIs, vancomycin has been the reference standard, but clinical failures have been reported increasingly. Alternative agents for HA-MRSA include linezolid, which has been well-studied for treatment of cSSTIs, as well as daptomycin and tigecycline. A number of antibiotic agents are undergoing clinical trials or are under development for the treatment of cSSTIs caused by MRSA.


CONCLUSIONS
Severe and progressive cSSTIs should be treated promptly with appropriate antibiotic agents. The choice of agent should be guided by a number of factors, including suspected CA-MRSA or HA-MRSA infection. Available agents should be evaluated carefully for efficacy in the treatment of MRSA cSSTIs.
Napolitano
Lena M
LM
Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0033, USA. lenan@umich.edu
D000890:Anti-Infective Agents / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000188:drug therapy; D006801:Humans; D007263:Infusions, Parenteral; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D018461:Soft Tissue Infections / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D013530:Surgical Wound Infection / Q000188:drug therapy
D000890:Anti-Infective Agents