J Rello, A Torres, M Ricart, J Valles, J Gonzalez, A Artigas and R Rodriguez- Roisin
Hospital Clinic de Barcelona, University of Barcelona, Spain.

All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. MRSA-infected persons were more likely to have received steroids before developing infection (relative risk [RR] = 3.45, 95% confidence interval [CI] = 1.38-8.59), to have been ventilated > 6 d (RR = 2.03, 95% CI = 1.36-3.03), to have been older than 25 yr (RR = 1.50, 95% CI = 1.09-2.06), and to have had preceding chronic obstructive pulmonary disease (RR = 2.76, 95% CI = 0.89-8.56) than MSSA-infected patients. MSSA-infected persons were more likely than MRSA-infected patients to have cranioencephalic trauma (RR = 1.94, 95% CI = 1.22-3.09). All patients with MRSA VAP had previously received antibiotics, compared with only 21.1% of those with MSSA infection (p < 0.000001). The incidence of empyema was similar in both groups; nevertheless, the presence of bacteremia and septic shock was more frequent in the MRSA group. Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% CI = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				Z. Athanassa, I. I. Siempos, and M. E. Falagas Impact of methicillin resistance on mortality in Staphylococcus aureus VAP: a systematic review Eur. Respir. J., March 1, 2008; 31(3): 625 - 632. [Abstract] [Full Text] [PDF]

				L. Vidaur, K. Planas, R. Sierra, G. Dimopoulos, A. Ramirez, T. Lisboa, and J. Rello Ventilator-Associated Pneumonia: Impact of Organisms on Clinical Resolution and Medical Resources Utilization Chest, March 1, 2008; 133(3): 625 - 632. [Abstract] [Full Text] [PDF]

				P. D Mauldin, C. D Salgado, V. L Durkalski, and J. A Bosso Nosocomial Infections Due to Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: Relationships with Antibiotic Use and Cost Drivers Ann. Pharmacother., March 1, 2008; 42(3): 317 - 326. [Abstract] [Full Text] [PDF]

				K. E. Kollef, R. M. Reichley, S. T. Micek, and M. H. Kollef The Modified APACHE II Score Outperforms Curb65 Pneumonia Severity Score as a Predictor of 30-Day Mortality in Patients With Methicillin-Resistant Staphylococcus aureus Pneumonia Chest, February 1, 2008; 133(2): 363 - 369. [Abstract] [Full Text] [PDF]

				E. Tacconelli, G. De Angelis, M. A. Cataldo, E. Pozzi, and R. Cauda Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis J. Antimicrob. Chemother., January 1, 2008; 61(1): 26 - 38. [Abstract] [Full Text] [PDF]

				T. P. Lodise Jr., P. S. McKinnon, D. P. Levine, and M. J. Rybak Impact of Empirical-Therapy Selection on Outcomes of Intravenous Drug Users with Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus Antimicrob. Agents Chemother., October 1, 2007; 51(10): 3731 - 3733. [Abstract] [Full Text] [PDF]

				J. Rello Importance of appropriate initial antibiotic therapy and de-escalation in the treatment of nosocomial pneumonia Eur. Respir. Rev., August 1, 2007; 16(103): 33 - 39. [Abstract] [Full Text] [PDF]

				D. O Maclayton and R. G Hall II Pharmacologic Treatment Options for Nosocomial Pneumonia Involving Methicillin-Resistant Staphylococcus aureus Ann. Pharmacother., February 1, 2007; 41(2): 235 - 244. [Abstract] [Full Text] [PDF]

				J. Rello and J. Mallol Optimal Therapy for Methicillin-Resistant Staphylococcus aureus Pneumonia: What Is the Best Dosing Regimen? Chest, October 1, 2006; 130(4): 938 - 940. [Full Text] [PDF]

				M. N. Jeffres, W. Isakow, J. A. Doherty, P. S. McKinnon, D. J. Ritchie, S. T. Micek, and M. H. Kollef Predictors of Mortality for Methicillin-Resistant Staphylococcus aureus Health-Care-Associated Pneumonia: Specific Evaluation of Vancomycin Pharmacokinetic Indices. Chest, October 1, 2006; 130(4): 947 - 955. [Abstract] [Full Text] [PDF]

				K. A. Davis Ventilator-associated pneumonia: a review. J Intensive Care Med, July 1, 2006; 21(4): 211 - 226. [Abstract] [PDF]

				J. A. Bosso and P. D. Mauldin Using Interrupted Time Series Analysis To Assess Associations of Fluoroquinolone Formulary Changes with Susceptibility of Gram-Negative Pathogens and Isolation Rates of Methicillin-Resistant Staphylococcus aureus. Antimicrob. Agents Chemother., June 1, 2006; 50(6): 2106 - 2112. [Abstract] [Full Text] [PDF]

				J D Hunter Ventilator associated pneumonia. Postgrad. Med. J., March 1, 2006; 82(965): 172 - 178. [Abstract] [Full Text] [PDF]

				M. H. Kollef and S. T. Micek Staphylococcus Aureus Pneumonia: A "Superbug" Infection in Community and Hospital Settings Chest, September 1, 2005; 128(3): 1093 - 1097. [Full Text] [PDF]

				C. A. DeRyke, T. P. Lodise Jr., M. J. Rybak, and P. S. McKinnon Epidemiology, Treatment, and Outcomes of Nosocomial Bacteremic Staphylococcus aureus Pneumonia Chest, September 1, 2005; 128(3): 1414 - 1422. [Abstract] [Full Text] [PDF]

				S. E. Cowie, I. Ma, S. K. Lee, R. M. Smith, and Y. N. Hsiang Nosocomial MRSA Infection in Vascular Surgery Patients: Impact on Patient Outcome Vascular and Endovascular Surgery, July 1, 2005; 39(4): 327 - 334. [Abstract] [PDF]

				J. Weigelt, K. Itani, D. Stevens, W. Lau, M. Dryden, C. Knirsch, and the Linezolid CSSTI Study Group Linezolid versus Vancomycin in Treatment of Complicated Skin and Soft Tissue Infections Antimicrob. Agents Chemother., June 1, 2005; 49(6): 2260 - 2266. [Abstract] [Full Text] [PDF]

				Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 388 - 416. [Full Text] [PDF]

				J. J. De Waele, D. Vogelaers, E. Hoste, S. Blot, and F. Colardyn Emergence of Antibiotic Resistance in Infected Pancreatic Necrosis Arch Surg, December 1, 2004; 139(12): 1371 - 1375. [Abstract] [Full Text] [PDF]

				D S Thompson Methicillin-resistant Staphylococcus aureus in a general intensive care unit J R Soc Med, November 1, 2004; 97(11): 521 - 526. [Abstract] [Full Text] [PDF]

				A. Combes, C.-E. Luyt, J.-Y. Fagon, M. Wollf, J.-L. Trouillet, C. Gibert, and J. Chastre Impact of Methicillin Resistance on Outcome of Staphylococcus aureus Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., October 1, 2004; 170(7): 786 - 792. [Abstract] [Full Text] [PDF]

				K. J. Hardy, P. M. Hawkey, F. Gao, and B. A. Oppenheim Methicillin resistant Staphylococcus aureus in the critically ill Br. J. Anaesth., January 1, 2004; 92(1): 121 - 130. [Abstract] [Full Text] [PDF]

				K. Yamazaki, S. Ogura, A. Ishizaka, T. Oh-hara, and M. Nishimura Bronchoscopic Microsampling Method for Measuring Drug Concentration in Epithelial Lining Fluid Am. J. Respir. Crit. Care Med., December 1, 2003; 168(11): 1304 - 1307. [Abstract] [Full Text] [PDF]

				R. G. Wunderink, J. Rello, S. K. Cammarata, R. V. Croos-Dabrera, and M. H. Kollef Linezolid vs Vancomycin: Analysis of Two Double-Blind Studies of Patients With Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia Chest, November 1, 2003; 124(5): 1789 - 1797. [Abstract] [Full Text] [PDF]

				R. T. Horvat, N. E. Klutman, M. K. Lacy, D. Grauer, and M. Wilson Effect of Duplicate Isolates of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus on Antibiogram Data J. Clin. Microbiol., October 1, 2003; 41(10): 4611 - 4616. [Abstract] [Full Text] [PDF]

				R. P. Baughman and M. A. Kerr Ventilator-Associated Pneumonia Patients who Do Not Reduce Bacteria from the Lungs have a Worse Prognosis J Intensive Care Med, September 1, 2003; 18(5): 269 - 274. [Abstract] [PDF]

				O. Leroy, S. Jaffre, T. d'Escrivan, P. Devos, H. Georges, S. Alfandari, and G. Beaucaire Hospital-Acquired Pneumonia: Risk Factors for Antimicrobial-Resistant Causative Pathogens in Critically Ill Patients Chest, June 1, 2003; 123(6): 2034 - 2042. [Abstract] [Full Text] [PDF]

				G. Hoffken and M. S. Niederman Nosocomial Pneumonia: The Importance of a De-escalating Strategy for Antibiotic Treatment of Pneumonia in the ICU Chest, December 1, 2002; 122(6): 2183 - 2196. [Abstract] [Full Text] [PDF]

				A. A. El-Solh, A. T. Aquilina, R. S. Dhillon, F. Ramadan, P. Nowak, and J. Davies Impact of Invasive Strategy on Management of Antimicrobial Treatment Failure in Institutionalized Older People with Severe Pneumonia Am. J. Respir. Crit. Care Med., October 15, 2002; 166(8): 1038 - 1043. [Abstract] [Full Text] [PDF]

				A. Rano, C. Agusti, N. Benito, M. Rovira, J. Angrill, T. Pumarola, and A. Torres Prognostic Factors of Non-HIV Immunocompromised Patients With Pulmonary Infiltrates* Chest, July 1, 2002; 122(1): 253 - 261. [Abstract] [Full Text] [PDF]

				A S Haddadin, S A Fappiano, and P A Lipsett Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit Postgrad. Med. J., July 1, 2002; 78(921): 385 - 392. [Abstract] [Full Text] [PDF]

				J. Chastre and J.-Y. Fagon Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., April 1, 2002; 165(7): 867 - 903. [Abstract] [Full Text] [PDF]

				M. Iregui and M. H. Kollef Prevention of Ventilator-Associated Pneumonia : Selecting Interventions That Make a Difference Chest, March 1, 2002; 121(3): 679 - 681. [Full Text] [PDF]

				H. HERKNER, M. R. MULLER, N. KREISCHITZ, B. X. MAYER, M. FROSSARD, C. JOUKHADAR, N. KLEIN, E. LACKNER, and M. MULLER Closed-Chest Microdialysis to Measure Antibiotic Penetration into Human Lung Tissue Am. J. Respir. Crit. Care Med., January 15, 2002; 165(2): 273 - 276. [Abstract] [Full Text] [PDF]

				J. Rello, J. A. Paiva, J. Baraibar, F. Barcenilla, M. Bodi, D. Castander, H. Correa, E. Diaz, J. Garnacho, M. Llorio, et al. International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-Associated Pneumonia Chest, September 1, 2001; 120(3): 955 - 970. [Abstract] [Full Text] [PDF]

				E. H. Ibrahim, L. Tracy, C. Hill, V. J. Fraser, and M. H. Kollef The Occurrence of Ventilator-Associated Pneumonia in a Community Hospital : Risk Factors and Clinical Outcomes Chest, August 1, 2001; 120(2): 555 - 561. [Abstract] [Full Text] [PDF]

				M. Ioanas, R. Ferrer, J. Angrill, M. Ferrer, and A. Torres Microbial investigation in ventilator-associated pneumonia Eur. Respir. J., April 1, 2001; 17(4): 791 - 801. [Abstract] [Full Text] [PDF]

				J. P. Lynch III Hospital-Acquired Pneumonia : Risk Factors, Microbiology, and Treatment Chest, February 1, 2001; 119(2_suppl): 373S - 384S. [Abstract] [Full Text] [PDF]

				S. Fiel Guidelines and Critical Pathways for Severe Hospital-Acquired Pneumonia Chest, February 1, 2001; 119(2_suppl): 412S - 418S. [Abstract] [Full Text] [PDF]

				H. Watanabe, H. Masaki, N. Asoh, K. Watanabe, K. Oishi, S. Kobayashi, A. Sato, and T. Nagatake Molecular Analysis of Methicillin-Resistant Staphylococcus aureus as a Causative Agent of Bronchopulmonary Infection: Relation to Colonization in the Upper Respiratory Tract J. Clin. Microbiol., October 1, 2000; 38(10): 3867 - 3869. [Abstract] [Full Text]

				D. GRUSON, G. HILBERT, F. VARGAS, R. VALENTINO, C. BEBEAR, A. ALLERY, C. BEBEAR, G. GBIKPI-BENISSAN, and J.-P. CARDINAUD Rotation and Restricted Use of Antibiotics in a Medical Intensive Care Unit . Impact on the Incidence of Ventilator-associated Pneumonia Caused by Antibiotic-resistant Gram-negative Bacteria Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 837 - 843. [Abstract] [Full Text]

				R. S. Morehead and S. J. Pinto Ventilator-Associated Pneumonia Arch Intern Med, July 10, 2000; 160(13): 1926 - 1936. [Abstract] [Full Text] [PDF]

				E. H. Ibrahim, S. Ward, G. Sherman, and M. H. Kollef A Comparative Analysis of Patients With Early-Onset vs Late-Onset Nosocomial Pneumonia in the ICU Setting Chest, May 1, 2000; 117(5): 1434 - 1442. [Abstract] [Full Text] [PDF]

				N. Singh and V. L. Yu Rational Empiric Antibiotic Prescription in the ICU Chest, May 1, 2000; 117(5): 1496 - 1499. [Abstract] [Full Text] [PDF]

				M. S. Niederman Bronchoscopy in Nonresolving Nosocomial Pneumonia Chest, April 1, 2000; 117(4_suppl_2): 212S - 218S. [Full Text] [PDF]

				J.-Y. FAGON, H. PATRICK, D. W. HAAS, A. TORRES, C. GIBERT, W. G. CHEADLE, R. E. FALCONE, J. D. ANHOLM, F. PAGANIN, T. C. FABIAN, et al. Treatment of Gram-positive Nosocomial Pneumonia . Prospective Randomized Comparison of Quinupristin/Dalfopristin versus Vancomycin Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 753 - 762. [Abstract] [Full Text] [PDF]

				J. RELLO, M. SA-BORGES, H. CORREA, S.-R. LEAL, and J. BARAIBAR Variations in Etiology of Ventilator-associated Pneumonia across Four Treatment Sites . Implications for Antimicrobial Prescribing Practices Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 608 - 613. [Abstract] [Full Text]

				J. RELLO, E. DIAZ, M. ROQUE, and J. VALLÉS Risk Factors for Developing Pneumonia within 48 Hours of Intubation Am. J. Respir. Crit. Care Med., June 1, 1999; 159(6): 1742 - 1746. [Abstract] [Full Text]

				J. Rello Acinetobacter baumannii Infections in the ICU : Customization is the Key Chest, May 1, 1999; 115(5): 1226 - 1229. [Full Text] [PDF]

				D. K. HEYLAND, D. J. COOK, L. GRIFFITH, S. P. KEENAN, and C. BRUN-BUISSON The Attributable Morbidity and Mortality of Ventilator-Associated Pneumonia in the Critically Ill Patient Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1249 - 1256. [Abstract] [Full Text] [PDF]

				P. Vannuffel, P.-F. Laterre, M. Bouyer, J. Gigi, B. Vandercam, M. Reynaert, and J.-L. Gala Rapid and Specific Molecular Identification of Methicillin-Resistant Staphylococcus aureus in Endotracheal Aspirates from Mechanically Ventilated Patients J. Clin. Microbiol., August 1, 1998; 36(8): 2366 - 2368. [Abstract] [Full Text]

				M. H. KOLLEF, J. VLASNIK, L. SHARPLESS, C. PASQUE, D. MURPHY, and V. FRASER Scheduled Change of Antibiotic Classes . A Strategy to Decrease the Incidence of Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1040 - 1048. [Abstract] [Full Text] [PDF]

				J.-L. TROUILLET, J. CHASTRE, A. VUAGNAT, M.-L. JOLY-GUILLOU, D. COMBAUX, M.-C. DOMBRET, and C. GIBERT Ventilator-associated Pneumonia Caused by Potentially Drug-resistant Bacteria Am. J. Respir. Crit. Care Med., February 1, 1997; 157(2): 531 - 539. [Abstract] [Full Text]