+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Methicillin-resistant Staphylococcus aureus prolongs intensive care unit stay in ventilator-associated pneumonia, despite initially appropriate antibiotic therapy

Methicillin-resistant Staphylococcus aureus prolongs intensive care unit stay in ventilator-associated pneumonia, despite initially appropriate antibiotic therapy

Critical Care Medicine 34(3): 700-706

To determine the impact of methicillin-resistant Staphylococcus aureus (MRSA) on length of stay in the intensive care unit (ICU) for patients with ventilator-associated pneumonia (VAP) and to control for the effect of initially inappropriate antibiotic treatment on outcomes by focusing only on persons who were given appropriate antibiotic therapy for their infection. Retrospective analysis of pooled, patient-level data from multiple clinical trials in VAP. Multiple ICUs in France. Persons with bronchoscopically confirmed VAP due to either MRSA or methicillin-susceptible S. aureus (MSSA) and who received initially appropriate antibiotic treatment. All persons with MRSA VAP received vancomycin (15 mg/kg intravenously, twice daily). None. We compared patients with MRSA VAP to persons with MSSA VAP. ICU length of stay represented the primary end point and ICU-free days served as a secondary end point. We recorded information regarding multiple confounders, including demographics, reasons for ICU admission and mechanical ventilation (MV), severity of illness at both ICU admission and time of diagnosis of VAP, and duration of mechanical ventilation before and following the onset of VAP. The final cohort included 107 patients, and one third of cases were due to MRSA. Despite receiving initially appropriate antibiotic treatment, median ICU length of stay was significantly longer for persons with MRSA infection (33 days vs. 22 days; p=.047). The median number of ICU-free days was concomitantly lower in MRSA VAP (0 days vs. 5 days; p=.011). Survival analysis employing a Cox proportional hazards model identified several predictors of remaining in the ICU: Pao2/Fio2 ratio at diagnosis of VAP, duration of MV before VAP, duration of MV after diagnosis of VAP, and reason for MV. Additionally, infection with MRSA as opposed MSSA doubled the probability of needing continued ICU care (hazard ratio, 2.08; 95% confidence interval, 1.09-3.95; p=.025). MRSA VAP independently prolongs the duration of ICU hospitalization, and in turn, increases overall costs, even for patients initially given appropriate antibiotic treatment. Confronting the adverse impact of MRSA will require efforts that address more than the initial antibiotic prescription.

(PDF emailed within 0-6 h: $19.90)

Accession: 049579942

Download citation: RISBibTeXText

PMID: 16505656

DOI: 10.1097/01.ccm.0000201885.57697.21

Related references

Methicillin-resistant Staphylococcus aureus nasal colonization is a poor predictor of intensive care unit-acquired methicillin-resistant Staphylococcus aureus infections requiring antibiotic treatment. Critical Care Medicine 38(10): 1991-1995, 2010

Could de-escalation of antibiotic therapy be feasible even for documented methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia?. Journal of Trauma 67(4): 893-4; Author Reply 894-5, 2009

Effect of pharmacists' intervention on the antibiotic therapy for the methicillin-resistant Staphylococcus aureus (MRSA) infectious diseases in the intensive care unit. Yakugaku Zasshi 131(4): 563-570, 2011

Correlation between methicillin-resistant Staphylococcus aureus nasal sampling and S. aureus pneumonia in the medical intensive care unit. Infection Control and Hospital Epidemiology 35(5): 590-593, 2014

Risk factors and outcome comparison of methicillin-resistant and methicillin-susceptible Staphylococcus aureus pneumonia in medical intensive care unit patients. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 37: 296, 1997

Quantitative PCR for Etiologic Diagnosis of Methicillin-Resistant Staphylococcus aureus Pneumonia in Intensive Care Unit. Tuberculosis and Respiratory Diseases 72(3): 293-301, 2012

Using a Longitudinal Model to Estimate the Effect of Methicillin-resistant Staphylococcus aureus Infection on Length of Stay in an Intensive Care Unit. Yearbook of Dermatology and Dermatologic Surgery 2011: 166-167, 2011

Using a longitudinal model to estimate the effect of methicillin-resistant Staphylococcus aureus infection on length of stay in an intensive care unit. American Journal of Epidemiology 170(9): 1186-1194, 2009

Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital. Revista Da Sociedade Brasileira de Medicina Tropical 45(1): 106-111, 2012

Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit. European Journal of Clinical Microbiology and Infectious Diseases 36(2): 267-272, 2016

Community-acquired Pneumonia with Methicillin-resistant Staphylococcus Aureus in a Patient Admitted to the Intensive Care Unit: A Therapeutic Challenge. Cureus 10(1): E2019, 2018

Effect of daily chlorhexidine bathing on the acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit with methicillin-resistant S aureus endemicity. American Journal of Infection Control 44(12): 1520-1525, 2016

Comparison of teicoplanin and linezolid therapies in patients with methicillin-resistant Staphylococcus aureus pneumonia acquired from respiratory intensive care unit. Mikrobiyoloji Bulteni 44(3): 357-366, 2012

Reduced incidence of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia in trauma patients: A new insight into the efficacy of the ventilator care bundle. Trauma 16(3): 202-206, 2014

Risk factors and evolution of ventilator-associated pneumonia by Staphylococcus aureus sensitive or resistant to oxacillin in patients at the intensive care unit of a Brazilian university hospital. Brazilian Journal of Infectious Diseases 12(6): 499-503, 2009