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| MeThicillin-ResisTanT sTaPhylococcal infecTions INFECTION PREVENTION strict hygiene practices are critical to limit transmission of methicillin-resistant staphylococci. Prudent hygiene practices include:7,48,64-67 • Barrier precautions, such as disposable gloves, when working with infected patients • covering open or draining wounds • frequent cleaning of dishes, washing of bedding, and environmental disinfection • Regular hand washing, especially after handling infected patients and between patients • Restricting infected pets from sleeping in bed with humans (or vice versa) and preventing pets from licking humans. To learn more about preventing spread of infection, read Practical Strategies for Preventing Nosocomial Infections (March/ April 2013 issue of Today's Veterinary Practice), available at todaysveterinarypractice.com. Figure 3. Superficial pyoderma in a dog; note the large epidermal collarettes and crusts on the ventral abdomen. Multidrug-resistant, methicillin-resistant s pseudintermedius was isolated on skin culture. Figure 4. Same dog from Figure 3 after 4 weeks of twice weekly bathing with 4% chlorhexidine-based shampoo and daily treatment with 3% chlorhexidinebased spray; no systemic antimicrobial therapy was administered Despite good in vitro susceptibility,8 administration of antimicrobials used in humans for serious MRSA infections, such as linezolid and vancomycin,60 should be avoided in veterinary patients due to ethical concerns (these drugs are reserved for use in humans with MRSA infections); cost of these medications is also prohibitive.61,62 Topical Therapy Topical antimicrobial therapy for resistant staphylococcal infections has increased due to: • Limited options for systemic therapy • Potential for adverse drug effects • Rise of multidrug resistance. Topical therapy alone has been found to be effective for treatment of pyoderma associated with methicillin-resistant staphylococci (Figures 3 and 4).59 Therapeutic options for sole or adjunctive therapy include:63 • Hypochlorous acid and sodium hypochlorite based products (including dilute bleach baths) • Mupirocin (2%) ointment • Shampoos, conditioners, sprays, and wipes containing chlorhexidine (2%–4%), benzoyl peroxide, or ethyl lactate • Wipes containing nisin, an antimicrobial protein. 30 Today's Veterinary Practice May/June 2013