Methicillin-resistant Staphylococcus aureus: Impact on dermatology practice

Methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) emerged in the 1960s and is now commonly seen in hospitals, clinics and, since the mid-1990s, the community. Risk factors for the acquisition of MRSA include chronic dermatoses, underlying medical illnesses, attending healthcare facilities, use of prescription antibacterials, surgery, intravenous lines, hospitalization in an intensive care unit, and proximity to patients colonized with MRSA. Recent community-associated strains often occur in patients without these risk factors. Staphylococci are readily spread from person to person and readily contaminate the environment. Infection control measures thus involve identifying the infected patients, separating them from other non-infected patients, cleaning of the environment and, most important of all, scrupulous attention to hand hygiene. Alcoholic antiseptic hand rubs offer an alternative to antiseptic hand washes and increase compliance. Treatment of MRSA skin infections is challenging. Topical agents such as mupirocin or fusidic acid can be used, but the organisms often become resistant. Systemic therapy involves non-β-lactams. Parenteral treatment is generally with glycopeptides such as vancomycin; oral therapy is more complex. Monotherapy with quinolones, rifampin (rifampicin), and fusidic acid often results in the development of resistance and so, if any of these agents are chosen it should be in combination. There are no data on combination therapy, although rifampin-containing combinations are often chosen. Fourth-generation quinolones and linezolid are expensive but promising alternatives.