In which settings is MRSA coverage routinely included in empiric therapy for skin and soft tissue infections?

• A. Purulent infections with systemic signs, abscesses, MRSA prevalence, diabetics, immunocompromised, or high-risk patients
• B. Nonpurulent cellulitis without systemic signs
• C. In all SSTIs, MRSA coverage is unnecessary
• D. MRSA coverage is only for outpatient minor infections

Answer: (B)

MRSA coverage in empiric therapy for skin and soft tissue infections is guided by the likely pathogens based on the clinical picture. When an infection is purulent (with pus or abscess) and there are systemic signs, or when the patient has risk factors such as high MRSA prevalence in the community, diabetes, immunosuppression, or other high-risk conditions, MRSA becomes a common pathogen and starting MRSA-active antibiotics empirically is appropriate. In contrast, nonpurulent cellulitis without systemic signs is more often caused by streptococci (and sometimes MSSA), and MRSA coverage is not routinely required in that scenario. So the settings that warrant routine MRSA coverage are the purulent infections with systemic involvement or high-risk factors, whereas nonpurulent cellulitis without systemic signs is typically managed without MRSA coverage.