Treating Staphylococcus aureus infections in an intensive care unit at a University Hospital in Brazil
- 215 Downloads
- 1 Citations
Abstract
Background Optimizing antimicrobial therapy is important for treating patients who are critically ill with Staphylococcus aureus infection, and susceptibility tests are necessary. Objective The aim of the present study was to evaluate antibacterial therapy after susceptibility testing of S. aureus infections. Setting The setting was an intensive care unit at a University Hospital in Brazil. Methods An observational and retrospective study was conducted over 6 years. The antimicrobials that were used for S. aureus infection treatment were calculated as the defined daily dose per 1000 patient-days (DDD1000). Antimicrobial susceptibility data were obtained by reviewing bacteriological tests. Patient profiles and treatment were determined by analyzing patient charts. Results Methicillin-resistant S. aureus (MRSA) was prevalent in this study (76.13 %). Patients who were infected with MRSA had total antimicrobial consumption that was three-times higher (9567.2 DDD1000) than patients who were infected with methicillin-susceptible S. aureus (MSSA; 3101.1 DDD1000). The average length of stay in the intensive care unit was 19 days (interquartile range 17 days) for MSSA and 20 days (interquartile range 20 days) for MRSA. Mortality in patients who were infected with MSSA was higher (52.17 %) than in patients who were infected with MRSA (33.80 %), and de-escalation was not identified in 73.90 % of MSSA patients.
Keywords
Antibiotics Brazil De-escalation MRSA MSSA Staphylococcus aureusNotes
Acknowledgments
The authors are grateful for the support of the hospital that was evaluated in the present study.
Funding
No financial support to declare.
Conflicts of interest
The authors declare no conflicts of interest.
References
- 1.Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.CrossRefPubMedGoogle Scholar
- 2.Hadler JL, Petit S, Mandour M, Cartter ML. Trends in invasive infection with methicillin-resistant Staphylococcus aureus, Connecticut, USA, 2001–2010. Emerg Infect Dis. 2012;18(6):917–24.CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Rossi F. The challenges of antimicrobial resistance in Brazil. Clin Infect Dis. 2011;52(9):1138–43.CrossRefPubMedGoogle Scholar
- 4.Luna CM, Rodríguez-Noriega E, Bavestrello L, Gotuzzo E. Treatment of methicillin-resistant Staphylococcus aureus in Latin America. Braz J Infect Dis. 2010;14(Suppl 2):S119–27.CrossRefPubMedGoogle Scholar
- 5.Niederman MS, Soulountsi V. De-escalation therapy: is it valuable for the management of ventilator-associated pneumonia? Clin Chest Med. 2011;32(3):517–34.CrossRefPubMedGoogle Scholar
- 6.Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, Lucet JC, et al. Elaboration of a consensual definition of de-escalation allowing a ranking of β-lactams. Clin Microbiol Infect. 2015;21(7):649.e1–10.CrossRefGoogle Scholar
- 7.Kim SH, Kim KH, Kim HB, Kim NJ, Kim EC, Oh MD, et al. Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Agents Chemother. 2008;52(1):192–7.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Bal AM, Garau J, Gould IM, Liao CH, Mazzei T, Nimmo GR, et al. Vancomycin in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) infection: end of an era? J Glob Antimicrob Resist. 2013;1(1):23–30.CrossRefGoogle Scholar
- 9.Lafaurie M, Porcher R, Donay JL, Touratier S, Molina JM. Reduction of fluoroquinolone use is associated with a decrease in methicillin-resistant Staphylococcus aureus and fluoroquinolone-resistant Pseudomonas aeruginosa isolation rates: a 10 year study. J Antimicrob Chemother. 2012;67(4):1010–5.CrossRefPubMedGoogle Scholar
- 10.Ribas RM, Freitas C, Gontijo-Filho PP. Nosocomial methicillin-resistant Staphylococcus aureus bacteremia in a tertiary care hospital: risk factors, overall mortality and antimicrobial resistance. Int J Med Sci. 2009;1(10):412–7.Google Scholar