title: Severe ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus and other pathogens: report of a case successfully managed by serial surveillance cultures of endotracheal aspirates.
abstract: Severe ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) developed in a patient with acute respiratory distress syndrome. After tracheostomy, the patient was treated with antibiotic therapy guided by serial surveillance cultures of endotracheal aspirates. According to the result of the culture, the suitable antibiotic targeting the pathogen (e.g., MRSA, Pseudomonas aeruginosa, Klebsiella oxytoca) that had grown most predominantly in the culture was used until clinical resolution of VAP, leading to avoidance of overusing broad-spectrum antibiotics and ultimately a favorable outcome. During vancomycin (VCM) therapy for MRSA VAP, MRSA bacteremia occurred even though the trough value of VCM was sufficiently high. After the change from VCM to linezolid (LZD), the VAP improved promptly, indicating that LZD is superior to VCM in the treatment of MRSA pneumonia.
authors.affiliation: Division of Hematology-Oncology and Infection Control Team, Chiba Cancer Center Hospital, 666-2 Nitona-cho, Chuo-ku, Chiba 260-8717, Japan. chisakai@chiba-cc.jp
authors.forename: Chikara
authors.initials: C
authors.lastname: Sakai
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Soda
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage; D006801:Humans; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D023303:Oxazolidinones / Q000627:therapeutic use; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology*; D012128:Respiratory Distress Syndrome / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid