Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides.
OBJECTIVE
To determine whether ventilator-associated pneumonia caused by oxacillin-resistant Staphylococcus aureus (VAP-ORSA) treated with glycopeptides is associated with an increased mortality rate.


METHODS
Retrospective matched cohort study.


METHODS
Four intensive care units in teaching hospitals.


METHODS
Seventy-five patients were matched to 75 controls.


METHODS
None.


RESULTS
All adult intensive care unit patients with microbiologically documented VAP-ORSA were matched to intubated controls who did not develop VAP-ORSA, based on disease severity (Acute Physiology and Chronic Health Evaluation II score) at admission (+/-3 points), diagnostic category, and length of stay before pneumonia onset. Population characteristics and intensive care unit mortality rates of patients with VAP-ORSA and their controls without pneumonia were compared. Attributable mortality was determined by subtracting the crude mortality rate of controls from the crude mortality rate of VAP-ORSA patients. Thirty-six of the 75 matched VAP-ORSA patients died, representing a crude mortality rate of 48%, whereas 19 of the 75 controls died, a crude mortality rate of 25.3% (p < .01). Excess mortality was estimated to be 22.7% (95% confidence interval, 2.4-42.9%). Median length of intensive care unit stay in the surviving pairs was 33 days (interquartile range, 25-75%: 25-45 days) for VAP-ORSA patients and 21 days (interquartile range, 25-75%: 15-34.75 days) days for controls (p = .054).


CONCLUSIONS
Despite appropriate glycopeptide therapy, there is an increased attributable mortality for pneumonia by ORSA, after careful adjustment for disease severity and diagnostic category.
Rello
Jordi
J
Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, Tarragona, Spain.
Sole-Violan
Jordi
J
Sa-Borges
Marcio
M
Garnacho-Montero
Jose
J
Muñoz
Emma
E
Sirgo
Gonzalo
G
Olona
Montserrat
M
Diaz
Emili
E
D018806:APACHE; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006020:Glycopeptides / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010068:Oxacillin / Q000494:pharmacology*; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects*; D017334:Teicoplanin / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use; D012122:Ventilators, Mechanical / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D017334:Teicoplanin; D014640:Vancomycin; D010068:Oxacillin