Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia.
The impact of methicillin resistance on morbidity and mortality of patients suffering from severe Staphylococcus aureus infections remains highly controversial. We analyzed a retrospective cohort of 97 patients with methicillin-susceptible and 74 patients with methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy was appropriate for every patient. Patients with methicillin-resistant Staphylococcus aureus VAP were older, had higher disease-severity scores, and had been on mechanical ventilation longer at onset of VAP. Factors associated with 28-day mortality retained by multivariate logistic regression analysis were: age (odds ratio [OR] = 1.05, 95% confidence interval [CI], 1.02-1.08, p = 0.001) and Day 1 organ dysfunctions or infection (ODIN) score (OR = 1.90, 95% CI, 1.31-2.78, p = 0.001), but not methicillin resistance (OR = 1.72, 95% CI, 0.73-4.05, p = 0.22). The percentages of infection relapse or superinfection did not differ significantly between the two patient groups. In conclusion, after controlling for clinical and physiologic heterogeneity between groups, methicillin resistance did not significantly affect 28-day mortality of patients with Staphylococcus aureus VAP receiving appropriate antibiotics.
Combes
Alain
A
Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, 75651 Paris Cedex 13, France. alain.combes@psl.ap-hop-paris.fr
Luyt
Charles-Edouard
CE
Fagon
Jean-Yves
JY
Wollf
Michel
M
Trouillet
Jean-Louis
JL
Gibert
Claude
C
Chastre
Jean
J
D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009017:Morbidity; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000382:microbiology; D010297:Paris / Q000453:epidemiology; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013211:Staphylococcus aureus; D015163:Superinfection / Q000453:epidemiology / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents