Any suggestions for treatment of Chronic MRSA of exit site? Is there any data for hydrotherapy or swimming in chlorinated water to help irraticate or heal Infection?

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Christine H, Nurse from Cleveland, OH asked
Any suggestions for treatment of Chronic MRSA of exit site? Is there any data for hydrotherapy or swimming in chlorinated water to help irraticate or heal Infection?

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I think many would recommend replacing the PD catheter when infected with MRSA. This can be done in one surgery if the effluent is clear and WBC 256), and failure was noted at an inoculum of > or =10(6) in the in vivo models. However, at a low inoculum (10(5)) in the murine thigh-infection model, clindamycin demonstrated modest activity, reducing the CFU/thigh count for clindamycin resistance-inducible strains at 72 h (0.45 to 1.3 logs). Overall, administration of daptomycin followed by vancomycin demonstrated the most significant kill against all strains in both models. Against the clindamycin noninducible strain, clindamycin and doxycycline demonstrated significant kill. Doxycycline, linezolid, and trimethoprim-sulfamethoxazide (not run in the murine model) demonstrated bacteriostatic activity against clindamycin resistance-inducible isolates. This study demonstrates that clindamycin’s activity against the iMLS(B) strains tested is partially impacted by inoculum size. At present, there are several alternatives that appear promising for treating clindamycin resistance-inducible strains of CA-MRSA.

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