Clinical and Epidemiological Study

Infection

, Volume 41, Issue 2, pp 517-523

First online:

Empiric therapy directed against MRSA in patients admitted to the intensive care unit does not improve outcomes in community-acquired pneumonia

  • A. T. GriffinAffiliated withDepartment of Medicine, Division of Infectious Diseases, University of Louisville Email author 
  • , P. PeyraniAffiliated withDepartment of Medicine, Division of Infectious Diseases, University of Louisville
  • , T. L. WiemkenAffiliated withDepartment of Medicine, Division of Infectious Diseases, University of Louisville
  • , J. A. RamirezAffiliated withDepartment of Medicine, Division of Infectious Diseases, University of Louisville
  • , F. W. ArnoldAffiliated withDepartment of Medicine, Division of Infectious Diseases, University of Louisville

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Abstract

Purpose

The Infectious Diseases Society of America has recommended empiric therapy active against methicillin-resistant Staphylococcus aureus (MRSA) for all community-acquired pneumonia (CAP) patients admitted to the intensive care unit (ICU). However, there is sparse data to support this recommendation. The objective of our study was to ascertain if such a practice improves outcomes.

Methods

This study was a secondary, retrospective analysis of the Community-Acquired Pneumonia Organization (CAPO) international database on CAP. Outcomes in patients admitted to the ICU were compared according to empiric initiation of anti-MRSA therapy (vancomycin or linezolid) with standard ICU CAP therapy (MRSA therapy group) or standard therapy alone for ICU CAP (standard therapy group).

Results

A total of 621 patients were identified with ICU pneumonia, of whom 57 patients had been initiated empirically on vancomycin or linezolid (MRSA therapy group). Patients of the MRSA therapy group had more comorbidities and were more severely ill than those of the standard therapy group. However, there were no statistical differences between the MRSA therapy group and standard therapy group for the primary outcomes of in-hospital and 28-day mortality, length of stay and time to clinical stability.

Conclusions

These findings suggest that empiric MRSA therapy in all ICU CAP patients may not improve outcomes and argue for clinician review of local epidemiologic trends on MRSA prevalence to ascertain the need for empiric MRSA coverage.

Keywords

MRSA Community-acquired pneumonia Intensive care