1. Failure to recognize MRSA soft-tissue infection. Conventional teaching is to treat skin and soft-tissue infections with agents such as cephalexin or its intravenous counterpart, cefazolin. Patients who fail to respond require either or both a culture and switch in treatment to include an agent that covers MRSA such as vancomycin, trimethoprim-sulfa, or linezolid. Failure to do so or delay in doing so can lead to necrotizing fasciitis, osteomyelitis and other life-threatening complications and death.
2. Patient with history of MRSA and recurrent soft-tissue infection is assumed to have MRSA until proven otherwise. To treat such a patient with a wound infection with an agent such as cephalexin delays appropriate therapy and subjects the patient to unnecessary complications.
3. Failure to appropriately screen for MRSA. Preoperative patients who undergo hardware or prosthesis material placement including vascular grafts are now recommended to be screened preop for MRSA. If screen is positive, the options are decolonization (which can take several days to a week) or use of prophylactic vancomycin preoperatively. Failure to take either of these steps can lead to hardware and wound infection.
4. Delays in recognition and treatment of MRSA bloodstream infections still occur, often with devastating results. No bacteremia with S. aureus, MRSA or MSSA is ever considered a “skin contaminant” (such thinking was common years ago but has been shown to be incorrect).
5. Failure to appreciate that a deep space infection usually requires drainage. This can occur with MRSA or MSSA but is more likely to be more devastating with MRSA.
6. Failure to appreciate side effects and limitations of therapies such as linezolid and vancomycin. Linezolid, for example, should never be used beyond two weeks due to bone marrow toxicity. It is also bacteristatic and not cidal which renders it suboptimal for osteomyelitis for which the drug is not FDA-approved.
I represented a client who developed necrotizing fasciitis due to MRSA because of unsanitary conditions in jail and we prevailed at trial. MRSA skin infections have been identified among certain populations that share close quarters or experience more skin-to-skin contact. is especially troublesome in hospitals and nursing homes, where patients with open wounds, invasive devices, and weakened immune systems are at greater risk of infection than the general public. More and more CA-MRSA infections are being increasingly seen in the general community as well.
I have used record reform for a complex case with multiple negligent events and I find the chronology that I received useful everytime I look at this case for any reason whatever.