From the Guidelines
Treatment for Staphylococcus aureus found in sputum cultures should be tailored to the specific strain's sensitivity, with methicillin-susceptible S. aureus (MSSA) treated with oxacillin, flucloxacillin, or 1st generation cephalosporin, and methicillin-resistant S. aureus (MRSA) treated with vancomycin or linezolid, as recommended by the most recent guidelines 1. When treating MRSA, it is essential to achieve a target trough serum concentration of vancomycin between 15 and 20 mg/mL 1. Precautions for Staph aureus found on sputum cultures include:
- Completing the entire antibiotic course even if symptoms improve
- Practicing good hand hygiene
- Covering wounds
- Not sharing personal items
- Isolating patients with MRSA in healthcare settings These measures are crucial because S. aureus can cause serious respiratory infections, particularly in those with underlying lung conditions or compromised immune systems, and may develop antibiotic resistance, making proper treatment and infection control essential to prevent spread and complications 1. Key considerations in the treatment of MRSA include the emergence of increasing minimum inhibitory concentrations (MICs) and toxin production, especially by community-acquired MRSA (CA-MRSA), which may require the use of alternative agents such as linezolid 1. In contrast to older guidelines 1, the most recent recommendations prioritize the use of vancomycin or linezolid for MRSA treatment, highlighting the importance of staying up-to-date with the latest evidence-based guidelines.
From the FDA Drug Label
Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins should be performed In the treatment of suspected staphylococcal infections, therapy should be changed to another active agent if culture tests fail to demonstrate the presence of staphylococci Periodic assessment of organ system function including renal, hepatic, and hematopoietic should be made during prolonged therapy with the penicillinase-resistant penicillins Blood cultures, white blood cell, and differential cell counts should be obtained prior to initiation of therapy and at least weekly during therapy with penicillinase-resistant penicillins Periodic urinalysis, blood urea nitrogen, and creatinine determinations should be performed during therapy with the penicillinase-resistant penicillins and dosage alterations should be considered if these values become elevated
The precautions for Staph aureus found on sputum cultures include:
- Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins
- Monitoring for the presence of staphylococci in culture tests and changing therapy to another active agent if necessary
- Periodic assessment of organ system function, including renal, hepatic, and hematopoietic function
- Blood cultures and urinalysis to monitor for possible adverse effects
- Dosage adjustments based on the results of these tests 2
- Caution when administering penicillins to patients with a history of significant allergies and/or asthma 3
- Monitoring of prothrombin times when using nafcillin and warfarin concomitantly 3
From the Research
Treatment of Staphylococcus aureus Infections
- The treatment of Staphylococcus aureus infections depends on the severity of the infection and the susceptibility of the strain to antibiotics 4.
- For methicillin-susceptible Staphylococcus aureus (MSSA) infections, beta-lactam antibiotics such as cephalosporins, oxacillin, or nafcillin are commonly used 4.
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin is often used, but other antibiotics such as linezolid may also be effective 5, 6.
- The empirical combination of vancomycin and a beta-lactam agent may be considered for Staphylococcal bacteremia, as it may improve infection-related clinical outcomes 7.
Precautions for Staphylococcus aureus Infections
- Patients with Staphylococcus aureus infections should be isolated to prevent the spread of the infection to others 4.
- Healthcare workers should wear personal protective equipment (PPE) such as gloves and masks when caring for patients with Staphylococcus aureus infections 4.
- Patients with Staphylococcus aureus infections should be monitored closely for signs of complications such as sepsis or respiratory failure 4.
- Antibiotic therapy should be tailored to the specific strain of Staphylococcus aureus and the severity of the infection, and should be adjusted based on culture and susceptibility results 8.
Management of Staphylococcus aureus Infections
- The management of Staphylococcus aureus infections requires a multidisciplinary approach, including antibiotic therapy, surgical intervention, and supportive care 4.
- Patients with Staphylococcus aureus infections should be educated on the importance of adherence to antibiotic therapy and follow-up appointments 4.
- Healthcare providers should be aware of the potential for antibiotic resistance and take steps to prevent its development, such as using antibiotics judiciously and monitoring for signs of resistance 4.