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Management of MRSA in the Community Setting: Getting it Right the First Time

  • Authors: Loren G. Miller, MD
  • CME/CE Released: 9/9/2009
  • Valid for credit through: 9/9/2010
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Target Audience and Goal Statement

This activity is intended primarily for primary care providers and other clinicians, and secondarily for infectious disease specialists, who care for patients at risk for or with Staphylococcal skin infections.

The goal of this activity is to address the unmet educational needs of clinicians who care for patients with Staphylococcal skin infections to optimize outcomes for patients with MRSA, as well as address related public health concerns.

Upon completion of this activity, participants will be able to:

  1. Identify best practices for early and accurate identification and management of MRSA skin infection in the community setting
  2. Select appropriate antibiotic therapy for patients with primary and recurrent MRSA skin infections in the community setting


As organizations accredited by the ACCME, NFID and MedscapeCME requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

NFID and MedscapeCME encourage Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Disclosed financial relationships have been reviewed by NFID to resolve any potential conflicts of interest. All faculty and planners have attested that the content of this activity will be based on the best available evidence; will promote quality healthcare, not a specific commercial interest; and will be well-balanced and unbiased.


  • Loren G. Miller, MD

    Associate Professor of Medicine, David Geffen School of Medicine, UCLA, Division of Infectious Diseases; Director, Infection Control Program, Harbor UCLA Medical Center, Torrance, CA


    Disclosure: Loren G. Miller, MD, MPH, has disclosed the following relevant financial relationships:
    Received grants for clinical research from: Cubist Pharmaceuticals and Pfizer Inc.


  • Susan L. Smith, MN, PhD

    Scientific Director, MedscapeCME


    Susan L. Smith, MN, PhD, has disclosed no relevant financial relationships.


  • Lauren Ero, MS

    Director, Continuing Medical Education, National Foundation for Infectious Diseases, Bethesda, Maryland


    Lauren Ero, MS, has disclosed no relevant financial relationships.

  • Susan J. Rehm, MD

    Medical Director, National Foundation for Infectious Diseases, Bethesda, Maryland; Vice Chair, Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio


    Disclosure: Susan J. Rehm, MD, has disclosed the following relevant financial relationships:
    Received grants for clinical research from: Cubist Pharmaceuticals
    Served as an advisor or consultant for: Cubist Pharmaceuticals; Pfizer Inc.
    Served as a speaker or member of a speaker’s bureau for: Cubist Pharmaceuticals; Roche Laboratories Inc.

Accreditation Statements

    For Physicians

  • The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education (CME) for physicians. NFID takes responsibility for the content, quality, and scientific integrity of this CME activity. Commercial supporters had no influence or control over the content of this activity.

    Sponsored by the National Foundation for Infectious Diseases

    NFID designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

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    For Nurses

  • NFID is an approved provider of continuing nursing education by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

    This educational activity has been approved for 1.0 contact hours for nurse participants.

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    For Pharmacists

  • Medscape, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

    Medscape, LLC designates this continuing education activity for 1.0 contact hour(s) (0.1 CEUs) (Universal Program Number 461-000-09-123-H01-P).

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

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Management of MRSA in the Community Setting: Getting it Right the First Time

Authors: Loren G. Miller, MDFaculty and Disclosures

CME/CE Released: 9/9/2009

Valid for credit through: 9/9/2010


The following test-and-teach case is an educational activity modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and will then read evidence-based information that supports the most appropriate answer choice. Please note that these questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the case, there will be a short post-test assessment based on material covered in the activity.

Patient History

TC, a 43-year-old man, presents to his physician's office with the chief complaint of a "bug bite" on his left leg that is mildly painful. He denies trauma to the affected area and notes that he did not actually see a bug bite him. He denies recent fever, chills, or sweats. His review of systems is otherwise unremarkable.

Social History

TC is married, smokes about half a pack of cigarettes daily, and drinks 2-3 beers on weekends, but otherwise does not consume alcohol. He denies any history of illicit or injection drug use. He is a construction worker living in Southern California with a history of intermittent lower back pain, but he is otherwise healthy. He notes that due to the nature of his work, he often suffers from skin abrasions and cuts.

Physical Examination

TC appears healthy. He is in minimal distress from pain, which he describes as 2 on a scale of 1 to 10. His vital signs are temperature, 99.2°F (37.3°C); blood pressure 136/72 mm Hg, and pulse 90 beats/minute. His examination is notable for a raised skin lesion (approximately 4 x 4 cm) on his left lower posterior leg (Figure 1). The lesion is fluctuant, warmth, tender, and erythematous. The remainder of his skin examination is unremarkable. Examination of the lungs, heart, and abdomen is normal.

Figure 1. Suppurative skin lesion approximately 4 x 4 cm showing surrounding erythema. Source: CDC. Image courtesy of Dale Losher.

Differential Diagnosis

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