title: Empiric therapy directed against MRSA in patients admitted to the intensive care unit does not improve outcomes in community-acquired pneumonia.
abstract: OBJECTIVE
  The Infectious Diseases Society of America has recommended empiric therapy active against methicillin-resistant Staphylococcus aureus (MRSA) for all community-acquired pneumonia (CAP) patients admitted to the intensive care unit (ICU). However, there is sparse data to support this recommendation. The objective of our study was to ascertain if such a practice improves outcomes.
  
  
  METHODS
  This study was a secondary, retrospective analysis of the Community-Acquired Pneumonia Organization (CAPO) international database on CAP. Outcomes in patients admitted to the ICU were compared according to empiric initiation of anti-MRSA therapy (vancomycin or linezolid) with standard ICU CAP therapy (MRSA therapy group) or standard therapy alone for ICU CAP (standard therapy group).
  
  
  RESULTS
  A total of 621 patients were identified with ICU pneumonia, of whom 57 patients had been initiated empirically on vancomycin or linezolid (MRSA therapy group). Patients of the MRSA therapy group had more comorbidities and were more severely ill than those of the standard therapy group. However, there were no statistical differences between the MRSA therapy group and standard therapy group for the primary outcomes of in-hospital and 28-day mortality, length of stay and time to clinical stability.
  
  
  CONCLUSIONS
  These findings suggest that empiric MRSA therapy in all ICU CAP patients may not improve outcomes and argue for clinician review of local epidemiologic trends on MRSA prevalence to ascertain the need for empiric MRSA coverage.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Louisville, 501 East Broadway, Suite 380, Louisville, KY, 40292, USA. atgrif01@louisville.edu
authors.forename: A T
authors.initials: AT
authors.lastname: Griffin
authors.forename: P
authors.initials: P
authors.lastname: Peyrani
authors.forename: T L
authors.initials: TL
authors.lastname: Wiemken
authors.forename: J A
authors.initials: JA
authors.lastname: Ramirez
authors.forename: F W
authors.initials: FW
authors.lastname: Arnold
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D036262:Empirical Research; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid