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Published ahead of print on July 8, 2004, doi:10.1164/rccm.200403-346OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 7, October 2004, 786-792

A more recent version of this article appeared on October 1, 2004
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Submitted on March 16, 2004
Accepted on July 7, 2004

Impact of Methicillin Resistance on Outcome of Staphylococcus aureus Ventilator-associated Pneumonia

Alain Combes1*, Charles-Edouard Luyt1, Jean-Yves Fagon2, Michel Wollf3, Jean-Louis Trouillet1, Claude Gibert1, and Jean Chastre1

1 Service de Reanimation Medicale, Hopital Pitie-Salpetriere, Paris, France, 2 Service de Reanimation Medicale, Hopital Europeen Georges-Pompidou, Paris, France, 3 Service de Reanimation Medicale, Hopital Bichat-Claude-Bernard Assistance Publique-Hopitaux de Paris, Paris, France

* To whom correspondence should be addressed. E-mail: alain.combes{at}psl.ap-hop-paris.fr.

The impact of methicillin resistance on morbidity and mortality of patients suffering from severe Staphylococcus aureus infections remains highly controversial. We analyzed a retrospective cohort of 97 patients with methicillin-susceptible and 74 patients with methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia. Initial empiric antibiotic therapy was appropriate for every patient. Patients with methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia were older, had higher disease-severity scores and had been on mechanical ventilation longer at ventilator-associated pneumonia onset. Factors associated with 28-day death retained by multivariate logistic regression analysis were: age (OR = 1.05, 95% CI, 1.02-1.08, p = 0.001) and day-1 ODIN score (OR = 1.90, 95% CI, 1.31-2.78, p = 0.001), but not methicillin resistance (OR = 1.72, 95% CI, 0.73-4.05, p = 0.22). The percentages of infection relapse or superinfection did not differ significantly between the 2 patient groups. In conclusion, after controlling for clinical and physiologic heterogeneity between groups, methicillin resistance did not significantly affect 28-day mortality of patients with Staphylococcus aureus ventilator-associated pneumonia receiving appropriate antibiotics.
Key words: Antibiotic-Resistant Bacteria, Respiration, Artificial, Outcome Assessment, Multivariate Models




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