From the Guidelines
Treatment of Staphylococcus aureus empyema should include antimicrobial therapy against MRSA, such as IV vancomycin or linezolid, in conjunction with drainage procedures. The choice of antibiotic therapy depends on the susceptibility of the strain, with vancomycin or linezolid being recommended options for MRSA pneumonia complicated by empyema 1.
Key Considerations
- Empirical therapy for MRSA is recommended pending sputum and/or blood culture results in hospitalized patients with severe community-acquired pneumonia, including those with empyema 1.
- The duration of antibiotic therapy should be 7-21 days, depending on the extent of infection, with the possibility of extending treatment for 2-6 weeks depending on clinical response.
- Drainage procedures, such as tube thoracostomy or video-assisted thoracoscopic surgery (VATS), are essential for the treatment of empyema, especially in cases of loculated empyemas.
Treatment Options
- IV vancomycin (A-II) or linezolid 600 mg PO/IV twice daily (A-II) are recommended for the treatment of MRSA pneumonia complicated by empyema 1.
- Clindamycin 600 mg PO/IV 3 times daily (B-III) may be considered if the strain is susceptible 1.
- Intrapleural fibrinolytics like alteplase with dornase alfa may help break down loculations, but their use should be individualized based on the patient's condition.
Clinical Approach
- Initial empiric therapy should include coverage for MRSA, with vancomycin or linezolid being suitable options.
- Drainage procedures should be performed promptly, with the choice of procedure depending on the location and extent of the empyema.
- Antibiotic therapy should be tailored based on culture and susceptibility results, with the duration of treatment depending on clinical response.
From the FDA Drug Label
5.9 Persisting or Relapsing S. aureus Bacteremia/Endocarditis Patients with persisting or relapsing S. aureus bacteremia/endocarditis or poor clinical response should have repeat blood cultures. The FDA drug label does not answer the question.
From the Research
Treatment Options for Staphylococcus aureus Empyema
- The treatment of Staphylococcus aureus empyema typically involves drainage and specific antibiotics such as vancomycin and linezolid 2, 3.
- However, there are increasing incidences of empyema refractory to vancomycin and linezolid, making alternative treatments necessary 2.
- Daptomycin has been shown to be effective in treating MRSA empyema, particularly when refractory to vancomycin 2, 3.
- Linezolid has also been found to be effective against MRSA bacteremia, with comparable effectiveness and safety to vancomycin, teicoplanin, or daptomycin 4.
Antibiotic Resistance and Treatment
- Staphylococcus aureus has developed resistance to various classes of antimicrobial drugs, including penicillins, sulfonamides, tetracyclines, and glycopeptides 5.
- Methicillin-resistant Staphylococcus aureus (MRSA) infections are typically treated with drugs such as vancomycin, teicoplanin, or daptomycin 5.
- Combination therapy with vancomycin and ceftaroline may be considered for patients with persistent MRSA bacteremia refractory to initial therapy 6.
Clinical Considerations
- The choice of antibiotic treatment for Staphylococcus aureus empyema depends on various factors, including the severity of the infection, the presence of antibiotic resistance, and the patient's clinical status 2, 3, 5.
- Adjunctive therapies such as surgery and intravenous immunoglobulin may also be considered in the treatment of Staphylococcus aureus infections 5.