Casette chromosome type Toxins

Susceptibility testing Antibiotic susceptibility pattern

Clinical features

Empiric antibiotic therapy

Young adults Community origin

In vitro Susceptibility = In vivo Effectiveness Pauci-resistant (susceptible to many antibiotics)

Severe necrotizing CAP Postviral influenza with PVL+ strains Nonsevere CAP with PVL— strains Severe pyomyositis/fasciitis with PVL+ strains Nonsevere cSSSI with PVL strains

Clindamycin Doxycycline TMP-SMX

Older adults/elderly Hospital origin SCCmec I, II, III PVL-

In vitro Susceptibility s In vivo Effectiveness Multidrug resistant (not susceptible to most antibiotics) Bacteremias Nosocomial ABE Skin/soft tissue infections Respiratory secretions colonization common in ventilator patients MRSA VAP uncommon Daptomycina Linezolida Tigecyclinea Minocyclinea Quinupristin/dalfopristina Vancomycina

Abbreviations: cSSSI, complicated skin/soft tissue infection; SCC, staphylococcal casette chromosome; VAP, ventilator-associated pneumonia. a Also effective against CA-MRSA.

Adapted from Cunha BA. Clinical manifestations and antimicrobial therapy of methicillin-resistant Staphylococcus aureus (MRSA). Clin Microbiol Infect 2005;11:33-42; Arshad S, Brown RB. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Infectious Disease Practice 2006;30:479-83; Cunha BA. Antibiotic essentials. 5th edition. Royal Oak (MI): Physicians' Press; 2006.


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