Risk factors and evolution of Ventilator-associated pneumonia by Staphylococcus aureus sensitive or resistant to oxacillin in patients at the intensive care unit of a Brazilian University Hospital

Moreira, Michel Rodrigues; Cardoso, Renata Lima; Almeida, Alair Benedito; Filho, Paulo Pinto Gontijo

doi:10.1590/s1413-86702008000600011

Cited by 15 publications

(10 citation statements)

References 37 publications

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“…7 Moreira e Gontijo Filho (2008) 34 researching the VAP's etiology in the adult critical care unit of the same hospital reported 41.2% of S. aureus isolates with 41.2% of MRSA.…”

Section: 28mentioning

confidence: 99%

Methicillin/Oxacillin-resistant Staphylococcus aureus as a hospital and public health threat in Brazil

Carvalho¹,

Mamizuka

Filho³

2010

Braz J Infect Dis

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“…7 Moreira e Gontijo Filho (2008) 34 researching the VAP's etiology in the adult critical care unit of the same hospital reported 41.2% of S. aureus isolates with 41.2% of MRSA.…”

Section: 28mentioning

confidence: 99%

Methicillin/Oxacillin-resistant Staphylococcus aureus as a hospital and public health threat in Brazil

Carvalho¹,

Mamizuka

Filho³

2010

Braz J Infect Dis

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“…This question is frequent in Brazilian ICUs 7 . Multidrug-resistant organisms are far higher in ICUs in Latin America, Asia, Africa, and Europe than in U.S. ICUs 8 .…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit

Moreira

Guimarães

Rodrigues

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Introduction: Antimicrobial resistance is an increasing threat in hospitalized patients, and inappropriate empirical antimicrobial therapy is known to adversely affect outcomes in ventilator-associated pneumonia (VAP). The aim of this study was to evaluate antimicrobial usage, incidence, etiology, and antimicrobial resistance trends for prominent nosocomial pathogens causing ventilatorassociated pneumonia in a clinical-surgical intensive care unit (ICU). Methods: Gram-negative bacilli and Staphylococcus aureus causing VAP, as well as their antimicrobial resistance patterns and data on consumption (defined daily dose [DDD] per 1,000 patient days) of glycopeptides, extended-spectrum cephalosporins, and carbapenems in the unit were evaluated in two different periods (A and B). Results: Antimicrobial use was high, mainly of broad-spectrum cephalosporins, with a significant increase in the consumption of glycopeptides (p < 0.0001) and carbapenems (p < 0.007) in period B. For Acinetobacter baumannii and members of the Enterobacteriaceae family, 5.27-and 3.06-fold increases in VAPs, respectively, were noted, and a significant increase in resistance rates was found for imipenem-resistant A. baumannii (p = 0.003) and third-generation cephalosporinsresistant Enterobacteriaceae (p = 0.01) isolates in this same period. Conclusions: Our results suggest that there is a link between antibiotics usage at institutional levels and resistant bacteria. The use of carbapenems was related to the high rate of resistance in A. baumannii and therefore a high consumption of imipenem/meropenem could play a major role in selective pressure exerted by antibiotics in A. baumannii strains.

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“…through a thorough evaluation of the risks and benefits of withholding empiric MRSA coverage. Trauma patients with bacteremia secondary to VAP may be a cohort warranting more aggressive empiric therapy given the higher risk of morbidity and mortality in this population [8,9]. Despite the risk factors discovered in this study, more information may needed to guide selection of patients who require empiric MRSA coverage for VAP, and to identify those in whom it would be safe to withhold MRSA coverage empirically.…”

Section: Limitationsmentioning

confidence: 99%

A Risk Factor Analysis for MRSA Ventilator-Associated Pneumonia to Guide Empiric Therapy in the Surgical Intensive Care Unit

E¹,

E²,

E³

et al. 2019

J Infect Dis Epidemiol

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Background: Methicillin resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) is increasing in prevalence. Treatment of VAP has moved toward ensuring patients are adequately covered for MRSA and other MDROs while balancing the need for antimicrobial stewardship and appropriateness of empiric coverage of these organisms in the setting of increasing resistance rates. The objective of this study was to identify the incidence of and risk factors for MRSA VAP in surgical intensive care unit (SICU) patients as a means to better identify patients at risk who would benefit from MRSA coverage empirically. Methods: This was a single-center, retrospective risk factor analysis of adult SICU patients, comparing patients with MRSA VAP to those with VAP due to alternative pathogens. Primary outcomes were incidence of MRSA VAP and risk factors associated with MRSA VAP. A multivariable logistic regression model was performed to identify risk factors for MRSA VAP. Results: Of 140 included patients, MRSA VAP occurred in 31 (22.1%). Fewer patients in the MRSA group were in septic shock (6.5 vs. 23.9%, p = 0.04) or hemodynamically unstable (16.1 vs. 34.9%, p = 0.03) at the time of VAP diagnosis. A lower proportion of MRSA patients had antibiotic exposure prior to VAP (58.1 vs. 78.9%, p = 0.03). Female sex was associated with a 2.3-fold higher risk for MRSA VAP and history of MRSA with a 4.2-fold higher risk, while patients with prior antibiotic exposure were 60% less likely to develop MRSA VAP. Conclusions: Ventilator-associated pneumonia due to MRSA was common among this SICU cohort. A history of MRSA infection and lack of prior antibiotic exposure may be useful factors to aid in selection of patients appropriate for empiric MRSA therapy. Risk factor analysis may be difficult in this population due inability to control for all patientspecific variables. Future risk factor studies investigating specific MDRO VAPs and the role of dysbiosis are needed to determine the appropriateness of empiric broad-spectrum therapy.

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Risk factors and evolution of Ventilator-associated pneumonia by Staphylococcus aureus sensitive or resistant to oxacillin in patients at the intensive care unit of a Brazilian University Hospital

Cited by 15 publications

References 37 publications

Methicillin/Oxacillin-resistant Staphylococcus aureus as a hospital and public health threat in Brazil

Methicillin/Oxacillin-resistant Staphylococcus aureus as a hospital and public health threat in Brazil

Antimicrobial use, incidence, etiology and resistance patterns in bacteria causing ventilator-associated pneumonia in a clinical-surgical intensive care unit

A Risk Factor Analysis for MRSA Ventilator-Associated Pneumonia to Guide Empiric Therapy in the Surgical Intensive Care Unit

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