Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients.
BACKGROUND
Screening for and treating gut carriage of methicillin-resistant Staphylococcus aureus (MRSA) may control transmission and subsequent endemicity of MRSA.


OBJECTIVE
Enteral vancomycin was evaluated as a measure to control an outbreak of MRSA infection in the intensive care unit (ICU).


METHODS
During the 8-month study of sequential design, 176 patients were admitted, 65 (37%) of whom required a minimum of 3 days of ventilation. Forty-four patients were studied in the first 5 months, during which traditional measures were reinforced (control group). During the following 3 months, 13 of 21 patients developed MRSA carriage and received 2 g/day of enteral vancomycin, with high standards of hygiene maintained (treatment group).


RESULTS
Thirty-three MRSA infections occurred in 22 patients (50%) in the control group, whereas 2 patients (9.5%) had 2 MRSA infections in the treatment group (P <.05 for carriage, infection rates, and episodes). Of the 33 MRSA infections in the control group, 27 were due to MRSA acquired in the ICU, whereas the 2 infections in the treatment group were primary endogenous (ie, caused by MRSA present in the patient's admission flora). The probability of developing an MRSA infection was reduced in patients receiving enteral vancomycin compared with patients in the control group (odds ratio, 0.37; 95% CI, 0.24-0.58). Enteral vancomycin significantly reduced the level of MRSA carriage; the mean carriage index was 1.01 in the control group versus 0.58 in the test group (P <.05). Neither vancomycin-resistant enterococci nor vancomycin-intermediate Staphylococcus aureus were isolated from either surveillance or diagnostic samples.


CONCLUSIONS
The eradication of MRSA gut carriage by enteral vancomycin in a small subset of ICU patients was effective in the control of an MRSA outbreak.
Silvestri
Luciano
L
Department of Emergency, Unit of Anesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Gorizia, Italy.
Milanese
Marco
M
Oblach
Luisa
L
Fontana
Francesco
F
Gregori
Dario
D
Guerra
Romano
R
van Saene
Hendrick K F
HK
D000368:Aged; D002353:Carrier State / Q000188:drug therapy / Q000382:microbiology; D004196:Disease Outbreaks; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008712:Methicillin / Q000494:pharmacology*; D016106:Methicillin Resistance; D008875:Middle Aged; D012121:Respiration, Artificial; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D013997:Time Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
D014640:Vancomycin; D008712:Methicillin