Infectious Disease Society of America Takes a Stand on MRSA Treatment

So how did you ring in the New Year….champagne?…fireworks?…resolutions? The Infectious Disease Society of America (IDSA) marked the occasion by releasing its very first official practice guidelines on treatment of MRSA infections in hospitals. These guidelines, published in the latest issue of the journal Clinical Infectious Diseases,1 are the first from this organization to specifically address MRSA as opposed to more general infection control procedures.

The IDSA guidelines were written by a 13 member panel of experts in infection control. The major areas addressed, summarized in point form, were as follows:

–         MRSA skin and soft tissue infections (cutaneous abscesses, cellulitis, deep tissue infections, surgical infections)

–         Recurrent MRSA skin and soft tissue infections

–         MRSA bacteremia (bloodstream infection and infective endocarditis)

–         MRSA pneumonia

–         MRSA bone and joint infections

–         MRSA central nervous system infections

In addition to the conditions above, the report also specifically dealt with adjunctive therapies for MRSA treatment, vancomycin dosing and considerations, and MRSA treatment of neonates. Although this particular set of guidelines did not address the issues of MRSA prevention or surveillance/screening, it did recommend nasal and topical MRSA decolonization therapy as part of the ongoing treatment for recurrent infections. Aside from the use of incision and drainage to treat minor localized abscesses, all of the treatment recommendations contained in this report were not surprisingly based on antibiotic therapy. Furthermore, it’s reasonable to believe that the guidelines were somewhat “touched” by industry, as most of the panel experts involved in the recommendations disclosed potential conflict of interest relationships with various big pharma companies.

To say that an official guidance for clinicians and other healthcare professionals on how to handle MRSA has been a long time coming would be an understatement. Considering that MRSA first emerged in American hospitals more than 25 years ago, you would think that the IDSA would have had something substantial to say about it far earlier. This is especially surprising given the dramatic year over year rise in MRSA infection rates since the turn of the century. For a comparison, in 2006 in the United Kingdom the Joint Working Party of the British Society of Antimicrobial Chemotherapy, the Hospital Infection Society, and the Infection Control Nurses Association published their guidelines on MRSA Control and Prevention in healthcare facilities.2 That was almost 5 years ago! Don’t get me wrong, I’m all for evidence-based medicine, but much of the literature on MRSA epidemiology and treatment has been around for years now. Seems like it may have been prudent for the IDSA to at least put out some preliminary guidelines a lot earlier based on previous study evidence?

To be fair, for a national high-profile group like the IDSA the issues surrounding treatment of MRSA infections get tangled up in the much more complex issues of misuse/overuse of antibiotics and the growing problem of bacterial resistance. For example, providing a recommendation to increase use of the antibiotic vancomycin may have a positive impact on MRSA outcomes, but must also be balanced with the knowledge that this will accelerate the generation of bacterial resistance to one of the “last-line” therapies for serious infectious diseases. Thus, the IDSA must always be conscious of the broader impacts of its recommendations in the field of infection control. This is in contrast to the individual clinician, who is only concerned about immediate and successful care of his or her patient. It is in this way that treatment of MRSA and other infections is unlike treatment of any other diseases – all decisions made and therapies given have the potential to affect the general population. This puts a huge responsibility on infection control policy makers like the IDSA, working with a limited and finite pool of treatment alternatives to draw on for recommendations.

1 Liu et al. (2011) Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children: Executive Summary. Clinical Infectious Diseases 52(3): 285-292

2 Coia et al. (2006) Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection 63S: S1-S44

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One Response to “Infectious Disease Society of America Takes a Stand on MRSA Treatment”

  1. I found your blog – http://mrsatopic.com/2011/01/infectious-disease-society-of-america-takes-a-stand-on-mrsa-treatment/ – on Digg recently and thought I’d check it out. I bookmarked it and will come back to check on some more posts later.

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