Antibiotic selection for MRSA: case presentations and review of the literature

Infection with methicillin-resistant Staphylococcus aureus (MRSA) is a growing presence in both the community and hospital settings. Initially, MRSA was a difficult to treat infection isolated to hospitalized patients. With the introduction of vancomycin and other newer antibiotics, successful treatment of nosocomial, or hospital-acquired MRSA (HA-MRSA) has become commonplace. More recently, MRSA has evolved independently in each community. These community-acquired MRSA (CA-MRSA) strains initially had more limited resistance profiles, but selective pressures have broadened the resistance in many areas. Given the evolution in resistance among MRSA isolates, choosing an appropriate antibiotic therapy is challenging. Here the authors present 3 cases of HA- and CA-MRSA from an inner-city, tertiary care center and review recent literature with regards to antibiotic selection and administration.