Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical and Epidemiological Study
  • Published:
Infection Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rubinstein E, Kollef M, Nathwani D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008;46:S378–85.

    Article  PubMed  Google Scholar 

  2. Francis JS, Doherty MC, Lopatin U, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton–Valentine leukocidin genes. Clin Infect Dis. 1997;40:100–7.

    Article  Google Scholar 

  3. Brulé N, Jaffré S, Chollet S, Germaud P, Chailleux E. Necrotizing pneumonia due to Staphylococcus aureus producing Panton-Valentine toxin. Rev Mal Respir. 2008;25:875–9.

    Article  PubMed  Google Scholar 

  4. Lobo L, Reed K, Wunderink R. Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Chest. 2010;138:130–6.

    Article  PubMed  CAS  Google Scholar 

  5. Salgado CD, Farr BM, Calfee DM. Community-acquired methicillin resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003;36:131–9.

    Article  PubMed  Google Scholar 

  6. Faria NA, Oliveira DC, Westh H. Epidemiology of emerging methicillin-resistant Staphylococcus aureus (MRSA) in Denmark: a nationwide study in a country with low prevalence of MRSA infection. J Clin Microbiol. 2005;43:1836–42.

    Article  PubMed  CAS  Google Scholar 

  7. Thomas R, Ferguson J, Coombs G, Gibson PG. Community-acquired methicillin-resistant Staphylococcus aureus pneumonia: a clinical audit. Respirology. 2011;16:926–31.

    Article  PubMed  Google Scholar 

  8. Li HT, Zhang TT, Huang J, Zhou YQ, Zhu JX, Wu BQ. Factors associated with the outcome of life-threatening necrotizing pneumonia due to community-acquired Staphylococcus aureus in adult and adolescent patients. Respiration. 2011;81:448–60.

    Article  PubMed  Google Scholar 

  9. Woodhead M, Blasi F, Ewig S, Garau J, et al. Guidelines for the management of adult lower respiratory tract infections-summary. Clin Microbiol Infect. 2011;17:1–24.

    Article  PubMed  Google Scholar 

  10. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011;52:e18–55.

    Article  PubMed  Google Scholar 

  11. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.

    Article  PubMed  CAS  Google Scholar 

  12. Lim WS, van der Eerden MM, Laing R, et al. Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.

    Article  PubMed  CAS  Google Scholar 

  13. Imai K, van Dyk D. Causal inference with general treatment regimes: generalizing the propensity score. J Am Stat Assoc. 2004;99:854–66.

    Article  Google Scholar 

  14. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.

    Article  PubMed  Google Scholar 

  15. Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest. 2008;133:610–7.

    Article  PubMed  Google Scholar 

  16. Luna CM, Famiglietti A, Absi R, et al. Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest. 2000;118:1344–54.

    Article  PubMed  CAS  Google Scholar 

  17. Frei CR, Attridge RT, Mortensen EM, et al. Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit. Clin Ther. 2010;32:293–9.

    Article  PubMed  CAS  Google Scholar 

  18. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America; American thoracic society. Infectious diseases society of America/American thoracic society guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.

    Article  PubMed  CAS  Google Scholar 

  19. Bodí M, Rodríguez A, Solé-Violán J, et al. Community-acquired pneumonia intensive care units (CAPUCI) study investigators. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to infectious diseases society of America guidelines on survival. Clin Infect Dis. 2005;14:1709–16.

    Article  Google Scholar 

  20. Soavi L, Signorini L, Stellini R, et al. Linezolid and clindamycin improve the outcome of severe, necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Infez Med. 2011;19:42–4.

    PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, University of Louisville, 501 East Broadway, Suite 380, Louisville, KY, 40292, USA

    A. T. Griffin, P. Peyrani, T. L. Wiemken, J. A. Ramirez & F. W. Arnold

Authors
  1. A. T. Griffin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Peyrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. L. Wiemken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. A. Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. W. Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. T. Griffin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Griffin, A.T., Peyrani, P., Wiemken, T.L. et al. Empiric therapy directed against MRSA in patients admitted to the intensive care unit does not improve outcomes in community-acquired pneumonia. Infection 41, 517–523 (2013). https://doi.org/10.1007/s15010-012-0363-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-012-0363-1

Keywords

Search

Navigation