Empirical Anti-MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for Pneumonia

Abstract

IMPORTANCEUse of empirical broad-spectrum antibiotics for pneumonia has increased owing to concern for resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA). The association of empirical anti-MRSA therapy with outcomes among patients with pneumonia is unknown, even for high-risk patients.OBJECTIVE To compare 30-day mortality among patients hospitalized for pneumonia receiving empirical anti-MRSA therapy vs standard empirical antibiotic regimens. DESIGN, SETTING, AND PARTICIPANTSRetrospective multicenter cohort study was conducted of all hospitalizations in which patients received either anti-MRSA or standard therapy for community-onset pneumonia in the Veterans Health Administration health care system from January 1, 2008, to December 31, 2013. Subgroups of patients analyzed were those with initial intensive care unit admission, MRSA risk factors, positive results of a MRSA surveillance test, and positive results of a MRSA admission culture. Primary analysis was an inverse probability of treatment-weighted propensity score analysis using generalized estimating equation regression; secondary analyses included an instrumental variable analysis. Statistical analysis was conducted from June 14 to November 20, 2019.EXPOSURES Empirical anti-MRSA therapy plus standard pneumonia therapy vs standard therapy alone within the first day of hospitalization.MAIN OUTCOMES AND MEASURES Risk of 30-day all-cause mortality after adjustment for patient comorbidities, vital signs, and laboratory results. Secondary outcomes included the development of kidney injury and secondary infections with Clostridioides difficile, vancomycin-resistant Enterococcus species, or gram-negative bacilli. RESULTS Among 88 605 hospitalized patients (86 851 men; median age, 70 years [interquartile range, 62-81 years]), empirical anti-MRSA therapy was administered to 33 632 (38%); 8929 patients (10%) died within 30 days. Compared with standard therapy alone, in weighted propensity score analysis, empirical anti-MRSA therapy plus standard therapy was significantly associated with an increased adjusted risk of death (adjusted risk ratio [aRR], 1.4 [95% CI, 1.3-1.5]), kidney injury (aRR, 1.4 [95% CI, 1.3-1.5]), and secondary C difficile infections (aRR, 1.6 [95% CI, 1.3-1.9]), vancomycin-resistant Enterococcus spp infections (aRR, 1.6 [95% CI, 1.0-2.3]), and secondary gram-negative rod infections (aRR, 1.5 [95% CI, 1.2-1.8]). Similar associations between anti-MRSA therapy use and 30-day mortality were found by instrumental variable analysis (aRR, 1.6 [95% CI, 1.4-1.9]) and among patients admitted to the intensive care unit (aRR, 1.3 [95% CI, 1.2-1.5]), those with a high risk for MRSA (aRR, 1.2 [95% CI, 1.1-1.4]), and those with MRSA detected on surveillance testing (aRR, 1.6 [95% CI, 1.3-1.9]). No significant favorable association was found between empirical anti-MRSA therapy and death among patients with MRSA detected on culture (aRR, 1.1 [95% CI, 0.8-1.4]).CONCLUSIONS AND RELEVANCE This study suggests that empirical anti-MRSA th...

Staphylococcus aureus including MRSA nasal carriage among hospital exposed and unexposed medical students

“…MRSA has also gained importance in geriatrics medicine as it has been associated with higher mortality rates in elderly patients even after using anti-MRSA therapy. [ 12 ] In this study, the prevalence of MRSA among the anterior nares of the healthy medical students of was found too far lower than other studies on the medical students and healthcare workers from other parts of India. [ 26 27 28 ] The student with MRSA nasal carriage was advised for mupirocin ointment treatment.…”

“…[ 11 ] Even after treating MRSA infections with empirical anti-MRSA therapy the mortality rate remains high specially among the geriatric patients. [ 12 ]…”

Frequency of Extensively Drug-Resistant Gram-Negative Pathogens in a Tertiary Care Hospital in Pakistan

“…All patients should undergo culture and sensitivity testing before antibiotics administration, and the use of antibiotics targetting resistant bacteria should not be used as empirical therapy. It has also been found by recent studies that empirical therapy targetting resistant species has no mortality benefit over the use of standard antibiotics, and only contributes to the phenomenon of increased resistance [ 23 ].…”

Advances in community-acquired pneumonia

“…Fortunately, subsequent research showed that not only was this phenomena probably limited to relatively few centers, 16 the introduction of HCAP resulted in a massive increase in broad-spectrum antibiotic use 17 that almost certainly harmed more patients than it benefited. 17,18 The new guidelines recommend that P. aeruginosa and MRSA are only covered if risk factors are present AND local data have confirmed that these pathogens are problematic. Acknowledging that many centers may not have local data currently, the guidelines further recommend that sputum and blood cultures be taken whenever broad-spectrum antibiotic coverage is used to generate this information.…”

“…Introduced in the 2005 hospital-acquired pneumonia guidelines, 15 HCAP was an attempt to recognize that in some centers there was a much larger number of patients presenting with pneumonia and organisms not covered by standard empiric therapy, typically Pseudomonas aeruginosa and MRSA. Fortunately, subsequent research showed that not only was this phenomena probably limited to relatively few centers, 16 the introduction of HCAP resulted in a massive increase in broad-spectrum antibiotic use 17 that almost certainly harmed more patients than it benefited. 17,18 The new guidelines recommend that P. aeruginosa and MRSA are only covered if risk factors are present AND local data have confirmed that these pathogens are problematic.…”