What is the risk factor for MRSA which require use vanco as empirical
First , your hospital should make Antibiogram to know real prevelance of mrsa in your icu ,
The pediatric age group, invasive HA-MRSA infections predominantly occur in children younger than one year of age, and hospital-onset HA-MRSA infections are more common than community-onset HA-MRSA infections (CO HA-MRSA)
Risk factors:
●Hospital onset HA-MRSA – Risk factors for hospital-onset HA-MRSA infection are listed below; the first three are the risk factors that traditionally define HA-MRSA:
•Presence of an invasive device at the time of admission
•History of MRSA infection or colonization
•History of surgery, hospitalization, or dialysis
•Prolonged hospitalization (>14 days)
•Surgery or surgical site infection
•Admission to intensive care unit or burn unit
•Endotracheal/tracheostomy/nasogastric tube
•Parenteral nutrition/enteral feedings
•Proximity to others with MRSA colonization or infection
●Community-onset HA-MRSA – Risk factors for CO HA-MRSA are not standardized; those identified in publications describing this category or review articles are listed below; the first three traditionally define HA-MRSA:
•Presence of an invasive device
•History of HA-MRSA infection or colonization
•History of surgery, hospitalization, or dialysis
•Chronic disease (other than asthma or eczema)
•Antibiotic use in the previous six months
•Tympanostomy tube for recurrent otitis media
•Day-care center attendance
•Household contact with identified risk factor
•Age younger than two years
Ref:
- Paintsil E. Pediatric community-acquired methicillin-resistant Staphylococcus aureus infection and colonization: trends and management. Curr Opin Pediatr. 2007 Feb;19(1):75-82. doi: 10.1097/MOP.0b013e32801261c9. PMID: 17224666.
- Gorwitz RJ. A review of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J. 2008 Jan;27(1):1-7. doi: 10.1097/INF.0b013e31815819bb. PMID: 18162929.
- Davis KA, Stewart JJ, Crouch HK, Florez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis. 2004 Sep 15;39(6):776-82. doi: 10.1086/422997. Epub 2004 Aug 27. PMID: 15472807.
- Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med. 1982 Sep;97(3):309-17. doi: 10.7326/0003-4819-97-3-309. PMID: 7114627.
- Zaoutis TE, Toltzis P, Chu J, Abrams T, Dul M, Kim J, McGowan KL, Coffin SE. Clinical and molecular epidemiology of community-acquired methicillin-resistant Staphylococcus aureus infections among children with risk factors for health care-associated infection: 2001-2003. Pediatr Infect Dis J. 2006 Apr;25(4):343-8. doi: 10.1097/01.inf.0000207403.67197.cc. PMID: 16567987.
- Hultén KG, Kaplan SL, Gonzalez BE, Hammerman WA, Lamberth LB, Versalovic J, Mason EO Jr. Three-year surveillance of community onset health care-associated staphylococcus aureus infections in children. Pediatr Infect Dis J. 2006 Apr;25(4):349-53. doi: 10.1097/01.inf.0000207404.50143.1e. PMID: 16567988.
- Purcell K, Fergie J. Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children’s Hospital. Arch Pediatr Adolesc Med. 2005 Oct;159(10):980-5. doi: 10.1001/archpedi.159.10.980. PMID: 16203945.
Infectious Diseases Society of America (IDSA) recommends for treatment of MRSA infections in children that choice of empiric therapy should be guided by knowledge of local resistance patterns.
Ref:
Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-e55 , correction can be found in Clin Infect Dis 2011 Aug 1;53(3):319, commentary can be found in Clin Infect Dis 2011 Aug 1;53(3):308.