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Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of bacteremia and osteomyelitis

Franklin D Lowy, MD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Methicillin resistance in Staphylococcus aureus is defined as an oxacillin minimum inhibitory concentration (MIC) ≥4 mcg/mL. Isolates resistant to oxacillin or methicillin are also resistant to other beta-lactam agents, including dicloxacillin and cefazolin [1,2].

The approach to treatment of invasive methicillin-resistant S. aureus (MRSA) infections in adults will be reviewed here. Vancomycin or daptomycin are the antibiotics of choice for the treatment of invasive MRSA infections [3]. Fluoroquinolones should not be used to treat invasive MRSA infections; resistance can emerge during therapy.

Issues related to the treatment of MRSA skin and soft tissue infections, the mechanisms of antibiotic resistance, epidemiology, detection, and prevention and control of MRSA are discussed separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of skin and soft tissue infections" and "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control".)

Issues related to the pharmacology of antimicrobial agents for treatment of MRSA are discussed separately. (See "Pharmacology of antimicrobial agents for treatment of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus".)

Issues related to management of patients with MRSA isolates with increased vancomycin MICs are discussed in detail separately. (See "Vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus infections".)


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