title: Differences in hospital- and ventilator-associated pneumonia due to Staphylococcus aureus (methicillin-susceptible and methicillin-resistant) between Europe and Latin America: a comparison of the EUVAP and LATINVAP study cohorts.
abstract: OBJECTIVE
  A comparison is made of epidemiological variables (demographic and clinical characteristics) and outcomes in patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) caused by methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) in the Latin American VAP (LATINVAP) vs. the European Union VAP (EUVAP) cohorts of patients admitted to intensive care units (ICUs).
  
  
  METHODS
  The EUVAP project was a prospective, multicenter observational study reporting 827 patients with HAP/VAP in 27 ICUs from 9 European countries. The LATINVAP project was a multicenter prospective observational study, with an identical design, performed in 17 ICUs from 4 Latin American countries involving 99 patients who developed HAP/VAP. Episodes of VAP/HAP caused by S. aureus, MSSA, and MRSA were compared in both cohorts.
  
  
  RESULTS
  Forty-five patients had S. aureus HAP/VAP in the EUVAP cohort vs. 11 patients in the LATINVAP cohort. More patients had MRSA in the LATINVAP study than in the EUVAP (45% vs. 33%). ICU mortality among patients with MSSA HAP/VAP in EUVAP was 10% vs. 50% for LATINVAP (OR=9.75, p=0.01). Fifteen patients in the EUVAP cohort developed MRSA HAP/VAP as opposed to 5 in LATINVAP. In the EUVAP study there was an ICU mortality rate of 33.3%. In the LATINVAP cohort, the ICU mortality rate was 60% (OR for death=3.0; 95%CI 0.24-44.7).
  
  
  CONCLUSIONS
  MRSA pneumonia was associated with poorer outcomes in comparison with MSSA. Our study suggests significant variability among European and Latin American ICU practices that may influence clinical outcomes. Furthermore, patients with pneumonia in Latin America have different outcomes.
authors: Critical Care Department, Vall d'Hebron University Hospital, IRVH, CIBERes, Barcelona, Spain. Jrello@crips.es
authors: J
authors: J
authors: Rello
authors: D
authors: D
authors: Molano
authors: M
authors: M
authors: Villabon
authors: R
authors: R
authors: Reina
authors: R
authors: R
authors: Rita-Quispe
authors: I
authors: I
authors: Previgliano
authors: E
authors: E
authors: Afonso
authors: M I
authors: MI
authors: Restrepo
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005060:Europe; D006801:Humans; D007362:Intensive Care Units; D007843:Latin America; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D011446:Prospective Studies