Treating Central Catheter–Associated Bacteremia Due to Methicillin-Resistant Staphylococcus aureus: Beyond Vancomycin

Abstract

Methicillin-resistant Staphylococcus aureus is a frequent cause of hospital-associated infections, including central catheter-associated bacteremia. Vancomycin has been the drug of choice for treating this type of bacteremia for decades in patients who have no contraindications to the antibiotic. However, resistance to vancomycin is an emerging problem. Newer antibiotics approved by the Food and Drug Administration have activity against methicillin-resistant S aureus. Some of the antibiotics also have activity against strains of S aureus that are intermediately susceptible or resistant to vancomycin. This article uses a case study to highlight the clinical signs of vancomycin failure and describes the indications for and appropriate use of alternative antimicrobials such as ceftaroline, daptomycin, linezolid, tigecycline, and telavancin. (Critical Care Nurse. 2016;36[4]:46-57) 1 S aureus is both a commensal skin organism and a pathogen. Colonization can lead to infection when a breach occurs in the skin or mucosal defense systems because of trauma or common procedures This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Discuss the signs of vancomycin failure in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) central catheter-associated bacteremia 2. Describe the indications for use of daptomycin and ceftaroline for treatment of MRSA central catheter-associated bacteremia 3. Verbalize at least 2 nursing interventions that help prevent MRSA central catheter-associated bacteremia