title: Methicillin-resistant Staphylococcus aureus in early ventilator-associated pneumonia: cause for concern?
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) accounts for almost 90% of infections in mechanically ventilated patients and more than one-quarter of all patients requiring intubation, with associated mortality rates as high as 70%. The rise in methicillin resistance within the community has led to a national increase in methicillin-resistant Staphylococcus aureus (MRSA) rates in early VAP and associated healthcare expenditure.
  
  
  METHODS
  Trauma patients identified via an institutional VAP database were stratified by gender, age, severity of shock (24-h transfusions), and severity of injury. The primary outcome measure was evaluation of the incidence and trend of early MRSA VAP over a 6-y period. Secondary outcomes examined the adequacy of our current empiric antibiotic regimen as it pertained to outcome variables, including mortality.
  
  
  RESULTS
  A total of 997 episodes of VAP were identified in 727 patients. Linear regression showed that the incidence of early Staphylococcus aureus (SA) VAP was stable over the 6-y period (slope=-0.911; p=0.490). Over the same 6 y, however, the percentage of MRSA in early SA VAP (slope=3.95; p=0.0154) and the incidence of early MRSA VAP increased. No difference in mortality was detected between early methicillin-susceptible SA and early MRSA VAP. After adjustment for age, ISS, and 24-h transfusion requirements, early MRSA was not an independent predictor of mortality (odds ratio [OR], 0.815; p=0.59).
  
  
  CONCLUSIONS
  Although the incidence of early SA VAP with methicillin resistance increased significantly within the first 7 d of admission, this study showed no difference in mortality and resource utilization between early VAP from MRSA and other causative organisms, despite lack of empiric MRSA coverage.
authors.affiliation: 1 Department of Pharmacy, the Regional Medical Center , Memphis, Tennessee.
authors.forename: David M
authors.initials: DM
authors.lastname: Hill
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schroeppel
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: L Paige
authors.initials: LP
authors.lastname: Clement
authors.forename: John P
authors.initials: JP
authors.lastname: Sharpe
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents