Severe Infections

Clinical Considerations

Urgent vascular assessment if pulseless foot

Inpatient management recommended

Tailor regimen based on culture and susceptibility results and patient response

  • History of MRSA infection or colonization

  • Household contact with a MRSA colonized individual

  • IV drug use

  • Homelessness

  • Incarcerated persons

  • Recent travel to or residing in an MRSA endemic region or community

Immediate Type-1 (IgE-mediated) hypersensitivity reactions to beta-lactams include but not limited to anaphylaxis, urticaria, angioedema, hypotension, bronchospasm, stridor, and pruritis.

Preferred Empiric Regimen

  • Dose adjustment required in renal impairment

IF MRSA SUSPECTED, then ADD

  • Adjust dose to a trough target of 10-15 mg/L

  • Dose adjustment required in renal impairment

Alternative Regimens

  • If true immediate allergy to penicillin or known/suspected MDR Gram-negative organism(s)

  • Dose adjustment required in renal impairment

OR

  • Dose adjustment required in renal impairment

PLUS

IF MRSA SUSPECTED, then ADD (to any of the above regimens)

  • Adjust dose to a trough target of 10-15 mg/L

  • Dose adjustment required in renal impairment

Duration and Route of Therapy

Dependent on site, severity and extent of infection, as well as other patient specific factors such as degree of surgical management and vascular status