VENTURA COUNTY MEDICAL CENTER
SANTA PAULA HOSPITAL
CLINICAL PRACTICE GUIDELINES / PROTOCOLS
MRSA: Methicillin Resistant Staphylococcus Aureus, Management of
The contents of this clinical practice guideline are to be used as a guide. Healthcare professionals should use sound clinical
judgment and individualize patient care. This CPG is not meant to be a replacement for
training, experience, CME or studying the latest literature and drug information.
There are two primary differences between Methicillin Resistant Staphylococcus aureus (MRSA) and
standard S. aureus (MSSA) – need for isolation, and choice of antibiotics. MSSA is sensitive to standard
antibiotics used for the treatment of S. aureus and does not need isolation. The following guidelines apply
only to MRSA. In accordance with SB 1058, certain patients will be screened for MRSA colonization.
ISOLATION
 Patients with a documented MRSA infection and/or colonization need isolation on all
subsequent hospitalizations.
VCMC follows current CDC isolation guidelines for all infections/contagious diseases. At this time MRSA
isolation includes contact isolation until culture negative. At this time, we do not reculture to test for MRSA
eradication due to presumed continued carriage of the MRSA organism. This practice is based on the
following data:
 Patients with MRSA infection continue to carry MRSA for a median of 8 months or longer
 Isolation is more cost effective than repeat culturing on subsequent admissions
 Eradication of MRSA carriage is difficult and may lead to increased resistance
TREATMENT
 Duration of treatment and route of administration of antibiotics based on clinical indicators.
Although isolation needs to continue indefinitely, treatment only needs to continue until eradication of
clinical infection.
 Patients identified with active infection with MRSA need to be treated with either oral or intravenous
antibiotics until clinically cleared of infection.
 Patients with a prior history of MRSA infection who develop another skin, wound or soft tissue
infection should be treated with empiric antibiotics with activity against MRSA.
 Patients with a prior history of MRSA infection who are readmitted for non-infectious illness (CHF,
CVA, etc.) need contact isolation due to presumed MRSA carriage, but they do not need MRSA
treatment.
 Patients with asymptomatic carriage or colonization of MRSA will be placed in contact isolation.
 Any patient placed in isolation for MRSA will be cohorted based upon antibiotic susceptibilities.
ANTIBIOTIC SELECTION
 Antibiotic selection should be based on the specific culture and sensitivities of an individual
patient’s infection.
Because MRSA continues to evolve in its antibiotic susceptibilities, empiric antibiotic choices should be
based on the most recent VCMC antibiogram (appended).
Prepared by: Stephan Philip, M.D.
Review/approval:
Infection Control Committee: 4/2006; 01/2009
Executive Committee: 4/2006; 01/2009