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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.


PMID: 16505656

DOI: 10.1097/01.CCM.0000201885.57697.21

Other references

van Spriel, A.B.; van Ojik, H.H.; Bakker, A.; Jansen, M.J.H.; van de Winkel, J.G.J., 2002: Mac-1 (CD11b/CD18) is crucial for effective Fc receptor-mediated immunity to melanoma. Antibody-reliant destruction of tumor cells by immune effector cells is mediated by antibody-dependent cellular cytotoxicity, in which Fc receptor (FcR) engagement is crucial. This study documents an important role for the beta(2) integrin Mac-1 (...

Savitsky, VE.; Evtushenko, VM.; Egorova, LI.; Kontorovich, AE.; Shabanov, YuYa., 1972: Cambrian of the Siberian Platform Judomian-Olenetsky type section Kuonamsky Complex deposits. Geol Geofiz Miner Syrya, 130: 1-200

Anonymous, 2012: Origin and Flow Dynamics of Perennial Groundwater in Continuous Permafrost Terrain using Isotopes and Noble Gases Case Study of the Fishing River, Northern Yukon, Canada. Perennially flowing groundwater discharges along a 15-km section of the Fishing Branch River, Yukon causing open water during winter and numerous discrete springs near Bear Cave Mountain. Groundwater flow occurs in karstified marine carbonate rock...

Knaus, U.G.; Heyworth, P.G.; Evans, T.; Curnutte, J.T.; Bokoch, G.M., 1991: Regulation of phagocyte oxygen radical production by the GTP-binding protein Rac 2. A major action of the microbicidal system of human neutrophils is the formation of superoxide anion (O2-) by a multicomponent oxidase that transfers electrons from the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH) to molecula...

Tuchmann, D.Plessis, H.; Mercierparot, L., 1957: Effect of reserpine on the mammary glands of female and male rats. Comptes Rendus des Seances de la Societe de Biologie et de Ses Filiales 151(4): 656-658

Warnecke, T.; Im, S.; Kaiser, C.; Hamacher, C.; Oelenberg, S.; Dziewas, R., 2017: Aspiration and dysphagia screening in acute stroke - the Gugging Swallowing Screen revisited. The Gugging Swallowing Screen (GUSS) is a tool to screen aspiration risk in acute stroke. We aimed to replicate its validity in a larger second cohort of patients with acute stroke, including the more severe with a National Institutes of Health St...

Bonde-Petersen, F., 1994: Health care during prolonged weightlessness in humans. The demands for accumulation of knowledge about the human adaptation to weightlessness of long duration and the implications for the health and well-being of the astronaut have become increasingly important also for the international space program...

Smith, D.F., 1990: Trypanosomatid transfection: stable introduction of DNA into protozoa. The use of transfection technology to introduce DNA into trypanosomatids is briefly discussed with regard to work on Leptomonas seymouri, Leishmania enriettii and L. major.

McKinley-Grant, L.J.; Idler, W.W.; Bernstein, I.A.; Parry, D.A.; Cannizzaro, L.; Croce, C.M.; Huebner, K.; Lessin, S.R.; Steinert, P.M., 1989: Characterization of a cDNA clone encoding human filaggrin and localization of the gene to chromosome region 1q21. Filaggrins are an important class of intermediate filament-associated proteins that interact with keratin intermediate filaments of terminally differentiating mammalian epidermis. They show wide species variations and their aberrant expression has...

Carolus, R.L.; Putnam, A.R.; Ruiz, M.R., 1971: M. R. Effects of soil applied herbicides and calcium on mineral composition of pea (Pimm sativum). Interactive influences were determined of soluble Ca at 100 lb and simazine at 1/8 and 1/4 pounds per acre applied singly and in combination with dinoseb at 3 pounds per acre, dichlobenil at 1 pounds per acre and trifluralin at 0.5 pounds per acre...