Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides

被引:113
作者
Rello, J [1 ]
Sole-Violan, J
Sa-Borges, M
Garnacho-Montero, J
Muñoz, E
Sirgo, G
Olona, M
Diaz, E
机构
[1] Univ Rovira & Virgili, Univ Hosp 23, Inst Pere Virgili, Tarragona, Spain
[2] Hosp Dr Negrin, Las Palmas Gran Canaria, Spain
[3] Hosp Son Latzer, Palma de Mallorca, Spain
[4] Univ Madrid, Hosp Doce Octobre, Madrid 3, Spain
[5] Univ Seville, Hosp Virgen Rocio, Seville, Spain
关键词
ventilator-associated pneumonia; vancomycin; oxacillin-resistant; Staphylococcus aureus; therapy; mortality; methicillin-resistant;
D O I
10.1097/01.CCM.0000178180.61305.1D
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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. Design: Retrospective matched cohort study. Setting: Four intensive care units in teaching hospitals. Patients. Seventy-five patients were matched to 75 controls. Interventions: None. Measurements and Main 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.
引用
收藏
页码:1983 / 1987
页数:5
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