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Infection

, Volume 41, Issue 2, pp 517–523 | Cite as

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

  • A. T. GriffinEmail author
  • P. Peyrani
  • T. L. Wiemken
  • J. A. Ramirez
  • F. W. Arnold
Clinical and Epidemiological Study

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 

Notes

Acknowledgments

CAPO investigators and affiliations: The authors gratefully acknowledge the work of the CAPO investigators in building and maintaining the CAPO data set. The CAPO investigators are: Drs. Forest Arnold, Diana Christensen, Paula Peyrani, and Julio Ramirez, University of Louisville, KY, USA; Dr. Raul Nakamatsu, Veterans Affairs Medical Center, Louisville, KY, USA; Dr. Kwabena Ayesu, Orlando Regional Medical Center, Orlando, FL, USA; Dr. Belinda Ostrowsky, Montefiore Medical Center and Weiler Hospital, New York, NY, USA; Dr. Thomas File, Jr., Summa Health System, Akron, OH, USA; Dr. Steven Burdette, Greene Memorial Hospital, Xenia, OH, USA; Dr. Stephen Blatt, Good Samaritan Hospital, Cincinnati, OH, USA; Dr. Marcos Restrepo, University of Texas Health Science Center, San Antonio, Texas; Dr. Jose Bordon, Providence Hospital, Washington, D.C., USA; Dr. Peter Gross, Hackensack University Medical Center, Hackensack, NJ, USA; Dr. Thomas Marrie, University of Alberta Hospital, Sturgeon Community Hospital, Grey Nuns Hospital, and Royal Alexandra Hospital, Edmonton, Alberta, Canada; Dr. Karl Weiss, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Canada; Dr. James Chalmers, Royal Infirmary of Edinburgh and Western General Hospital, Edinburgh, Scotland, UK; Dr. Tom Fardon, Ninewells Hospital, Dundee, Scotland, UK; Dr. Jorge Roig, Hospital Nostra Senyora de Meritxell, Escaldes, Andorra; Dr. Harmut Lode, City Hosp. E.v.Behring/Lungenklinik Heckeshorn, Berlin, Germany; Dr. Tobias Welte, Medizinische Hochschule Hannover, Hanover, Germany; Drs. Francesco Blasi and Stephano Aliberti, Instituto Malattie Respirattorio, University of Milan, Instituto di Recerca e Cura a Carattere Scientifico, Policlinico, Milan, Italy; Dr. Roberto Cosentini, Policlinico, Milan, Italy; Dr. Delfino Legnani, Ospedale L. Sacco, Milan, Italy; Giulia Cervi, Policlinico di Modena, Modena, Italy; Paolo Rossi, S. Maria della Misericordia, Udine, Italy; Dr. Antoni Torres, Instituto de Neumonologia y Cirugia Toracica, CIBER Enfermedades Respiratorias, Barcelona, Spain; Dr. Daniel Portela Ojales, Hospital Xeral-Cies, Vigo, Spain; Dr. Maria Bodi, Hospital Universitario Joan XXIII, Tarragona, Spain; Dr. Jose Porras, Hospital Sant Pau I Santa Tecla, Tarragona, Spain; Drs. Jordi Rello and Maria Bodi, Critical Care Department, Joan XXIII University Hospital, CIBER Enfermedades Respiratorias, University Rovira & Virgili, Tarragona, Spain; Dr. Rosario Menendez, Pneumology Service, Hospital Universitario La Fe; CIBER Enfermedades Respiratorias, Valencia, Spain; Dr. Daiana Stolz, Universitatsspital Basel, Basel, Switzerland; Dr. Guillermo Benchetrit, IDIM A. Lanari, Buenos Aires, Argentina; Eduardo Rodriguez, Hospital Espanol de La Plata, La Plata, Argentina; Dr. Jorge Corral, Hospital Dr Oscar Alende, Mar del Plata, Argentina; Dr. Jose Gonzalez, Hospital Enrique Tornu, Buenos Aires, Argentina; Dr. Lautaro de Vedia, Hospital Francisco J. Muniz, Buenos Aires, Argentina; Dr. Gustavo Lopardo, Profesor Bernardo Houssay, Buenos Aires, Argentina; Dr. Carlos Luna, Hospital de Clinicas, Buenos Aires, Argentina; Dr. Jorge Martinez, Instituto Medico Platense, La Plata, Argentina; Dr. Lucia Marzoratti, Sanatorio 9 de Julio, Tucuman, Argentina; Dr. Maria Rodriguez, Hospital Rodolfo Rossi, La Plata, Argentina; Dr. Alejandro Videla, Hospital Universitario Austral, Buenos Aires, Argentina; Dr. Federico Saavedra, Sanatorio Otamendi Miroli, Buenos Aires, Argentina; Dr. Horacio Lopez, Centro de Infectología, Buenos Aires, Argentina; Dr. Martin Gnoni, Sanatorio Central EMHSA, Bueno Aires, Argentina; Dr. Jose Gonzalez, Hospital Enrique Tornu, Buenos, Argentina; Dr. Patricio Jimenez, Hospital Clinico Regional, Santiago, Chile; Patricia Fernandez, Instituto Nacional del Torax, Santiago, Chile; Dr. Maria Parada, Clinica las Condes, Santiago, Chile; Alejandro Díaz Fuenzalida, Pontificia Universidad Católica de Chile, Santiago, Chile; Dr. Raul Riquelme, Hospital de Puerto Montt, Puerto Montt, Chile; Dr. Manuel Barros, Hospital Carlos van Buren Hospital, Valpraiso, Chile; Dr. Juan Manuel Luna, Hospital Nacional Roosevelt, Guatemala; Dr. Ivan Toala, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama City, Panama; Dr. Guillermo Arbo Oze de Morvil, Clinica San Roque y Centro Médico La Costa, Asuncion, Paraguay; Dr. Gonzalo Aiello, Maciel Hospital, Montevideo, Uruguay; Dr. Federico Arteta, Hospital Luis Gomez Lopez-Ascardio, Barquisimeto, Venezuela; Dr. Jose Delgado, Hospital Central Dr. Urquinaona, Maracaibo, Venezuela; Dr. Gur Levy, Hospital Universitario de Caracas, Caracas, Venezuela; Dr. Ludwig Rivero, Hospital Central Univ. Antonio M. Pineda, Barquisimeto, Venezuela; Dr. Benito Rodriguez, Hospital IVSS Dr. Domingo Guzman Lander, Barquisimeto, Venezuela; Dr. Mario Perez Mirabal, Hospital Universitario de Los Andes, Merida, Venezuela; Dr. Marilyn Mateo, University of Santo Thomas Hospital, Manila, Philippines; Dr. Myrna Mendoza, University of the Philippines and National Kidney and Transplant Institute, Manila, Philippines; Dr. Charles Feldman, Johannesburg Hospital, Johannesburg, South Africa.

Conflict of interest

All authors have no sources of funding to declare and no conflicts of interest to declare.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • A. T. Griffin
    • 1
    Email author
  • P. Peyrani
    • 1
  • T. L. Wiemken
    • 1
  • J. A. Ramirez
    • 1
  • F. W. Arnold
    • 1
  1. 1.Department of Medicine, Division of Infectious DiseasesUniversity of LouisvilleLouisvilleUSA

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