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Hospital-acquired pneumonia: methicillin resistance and intensive care unit admission

      Abstract

      Although epidemiologic investigations of hospital-acquired pneumonia have certain intrinsic limitations because of the heterogeneity of the study populations, the difficulties in making a clinical diagnosis of nosocomial pneumonia, and the need for better microbiologic assays, recent studies have provided new and important data concerning the role of Staphylococcus aureus in this disease. This pathogen has now been identified as the most frequent cause of nosocomial pneumonia in hospitals in both Europe and the United States among patients in general hospital units as well as in the intensive care unit (ICU). Patients who have been treated with mechanical ventilation are at especially high risk for S. aureus pneumonia. The incidence of nosocomial pneumonia related to methicillin-resistant S. aureus (MRSA) has increased in recent years in many countries, especially among patients in the ICU. Because hospitalized patients with suspected nosocomial pneumonia often have many risk factors for MRSA infection, it seems advisable to include coverage of MRSA in the initial therapeutic regimen for these patients until MRSA infection is excluded.
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      References

        • Stevens R.M.
        • Teres D.
        • Skillman J.J.
        • et al.
        Pneumonia in an intensive care unit.
        Arch Intern Med. 1974; 134: 106-111
        • Graybill J.R.
        • Marshall L.W.
        • Charache P.
        • Wallace C.R.
        • Melvin V.B.
        Nosocomial pneumonia.
        Am Rev Respir Dis. 1973; 108: 1130-1140
        • Emori T.G.
        • Gaynes R.P.
        An overview of nosocomial infections, including the role of the microbiology laboratory.
        Clin Microbiol Rev. 1993; 6: 428-442
        • Tablan O.C.
        • Anderson L.J.
        • Arden N.H.
        • et al.
        Guideline for prevention of nosocomial pneumonia.
        Infect Control Hosp Epidemiol. 1994; 15: 588-625
        • Fagon J.Y.
        • Chastre J.
        • Domart Y.
        • et al.
        Nosocomial pneumonia in patients receiving continuous mechanical ventilation.
        Am Rev Respir Dis. 1989; 139: 877-884
        • Bryan C.S.
        • Reynolds K.L.
        Bacteremic nosocomial pneumonia.
        Am Rev Respir Dis. 1984; 129: 668-671
        • Rello J.
        • Ausina V.
        • Ricart M.
        • Castella J.
        • Prats G.
        Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia.
        Chest. 1993; 104: 1230-1235
        • Jarvis W.R.
        • Martone W.J.
        Predominant pathogens in hospital infections.
        J Antimicrob Chemother. 1992; 29: 19-24
        • Bergmans D.
        • Bonten M.
        • Gaillard C.
        • et al.
        Clinical spectrum of ventilator-associated pneumonia caused by methicillin-sensitive Staphylococcus aureus.
        Eur J Clin Microbiol Infect Dis. 1996; 15: 437-445
        • Spencer R.C.
        Predominant pathogens found in the European Prevalence of Infection in Intensive Care Unit.
        Eur J Clin Microbiol Infect Dis. 1996; 15: 281-285
        • Dal Nogare A.R.
        Nosocomial pneumonia outside the intensive care unit.
        in: Niederman M.S. Sarosi G.A. Glassroth J. Respiratory Infections A Scientific Basis for Management. 1st ed. WB Saunders Co, Philadelphia1994: 139-146
        • Hugues J.M.
        • Culver D.H.
        • White J.W.
        • et al.
        Nosocomial infection surveillance, 1980-1982.
        MMWR. 1983; 32: 1SS-15SS
        • Bartlett J.G.
        • O’Keefe P.
        • Tally F.P.
        • Louis T.J.
        • Gorbach S.L.
        Bacteriology of hospital-acquired pneumonia.
        Arch Intern Med. 1986; 146: 868-871
        • Taylor G.D.
        • Buchanam-Chell M.
        • Kirkland T.
        • McKenzie M.
        • Wiens R.
        Bacteremic nosocomial pneumonia.
        Chest. 1995; 108: 786-788
        • Torres A.
        • Aznar R.
        • Gatell J.M.
        • et al.
        Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients.
        Am Rev Respir Dis. 1990; 142: 523-528
        • Rello J.
        • Valles J.
        • Jubert P.
        • et al.
        Lower respiratory tract infections following cardiac arrest and cardiopulmonary resuscitation.
        Clin Infect Dis. 1995; 21: 310-314
        • Antonelli M.
        • Moro M.L.
        • Capelli O.
        • et al.
        Risk factors for early onset pneumonia in trauma patients.
        Chest. 1994; 105: 224-229
        • Baker A.M.
        • Meredith J.W.
        • Haponik E.F.
        Pneumonia in intubated trauma patients.
        Am J Respir Crit Care Med. 1996; 153: 343-349
        • Rello J.
        • Ausina V.
        • Castelia J.
        • Net A.
        • Prats G.
        Nosocomial respiratory tract infections in multiple trauma patients.
        Chest. 1992; 102: 525-529
        • Espersen F.
        • Gabrielsen J.
        Pneumonia due to Staphylococcus aureus during mechanical ventilation.
        J Infect Dis. 1981; 144: 19-23
        • Rello J.
        • Quintana E.
        • Aussina V.
        • et al.
        Risk factors for Staphylococcus aureus nosocomial pneumonia in critically ill patients.
        Am Rev Respir Dis. 1990; 142: 1320-1324
        • Archibald L.
        • Phillips L.
        • Monnet D.
        • et al.
        Antimicrobial resistance in isolates from inpatients and outpatients in the United States.
        Clin Infect Dis. 1997; 24: 211-215
        • Layton M.C.
        • Hierholzer W.J.
        • Patterson J.E.
        The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital.
        Infect Control Hosp Epidemiol. 1995; 16: 12-17
        • Nettleman M.D.
        • Trilla A.
        • Frederickson M.
        • Pfaller M.
        Assigning responsibility.
        Am J Med. 1991; 91: 228S-232S
        • Linneman Jr, C.C.
        • Mason M.
        • Moore P.
        • et al.
        Methicillin-resistant Staphylococcus aureus.
        Am J Epidemiol. 1982; 115: 941-951
        • Jernigan J.A.
        • Clemence M.A.
        • Stott G.A.
        • et al.
        Control of methicillin-resistant Staphylococcus aureus at a University hospital.
        Infect Control Hosp Epidemiol. 1995; 16: 686-696
        • Boyce J.M.
        • White R.L.
        • Spruill E.Y.
        Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections.
        J Infect Dis. 1983; 148: 763
        • Iwahara T.
        • Ichiyama S.
        • Nada T.
        • Shimokata K.
        • Nakashima N.
        Clinical and epidemiologic investigations of nosocomial pulmonary infections caused by methicillin-resistant Staphylococcus aureus.
        Chest. 1994; 150: 826-831
        • CDC
        Nosocomial enterococci resistant to vancomycin.
        MMWR. 1993; 42: 597-599
        • Rello J.
        • Torres A.
        • Ricart M.
        • et al.
        Ventilator-associated pneumonia by Staphylococcus aureus.
        Am J Respir Crit Care Med. 1994; 150: 1545-1549
        • McGowan Jr, J.E.
        Antimicrobial resistance in hospital organisms and its relation to antibiotic use.
        Rev Infect Dis. 1983; 5: 1033-1048
        • Gastinne H.
        • Wolff M.
        • Delatour F.
        • Faurisson F.
        • Chevret S.
        A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics.
        N Engl J Med. 1992; 326: 594-599
        • ATS Consensus Statement
        Hospital-acquired pneumonia in adults.
        Am J Respir Crit Care Med. 1995; 153: 1711-1725
        • Schlewpna C.J.
        • Cobb K.
        A study of the etiologies and treatment of nosocomial pneumonia in a community-based teaching hospital.
        Infect Control Hosp Epidemiol. 1992; 13: 515-525
        • Rello J.
        • Aussina V.
        • Ricart M.
        • et al.
        Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia.
        Chest. 1993; 104: 1230-1235
      1. Fagon JY and The Global Synercid NP Study Group. Randomized, comparative, multicenter, open study of quinupristin/dalfopristin plus aztreonam versus vancomycin plus aztreonam in the treatment of gram-positive nosocomial pneumonia. In: Program and abstracts of the 20th International Congress of Chemotherapy; June 29–July 3, 1997; Sydney, Australia.

        • Alvarez-Luma F.
        • ICU-Acquired Pneumonia Study Group
        Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit.
        Intensive Care Med. 1996; 22: 387-394
        • Niederman M.S.
        • Torres A.
        • Summer W.
        Invasive diagnostic testing is not needed routinely to manage suspected ventilator-associated pneumonia.
        Am J Respir Crit Care Med. 1994; 150: 565-569
        • Chastre J.
        • Fagon J.Y.
        Invasive diagnostic testing should be routinely used to manage ventilated patients with suspected pneumonia.
        Am J Respir Crit Care Med. 1994; 150: 570-574