Management of Multi-Drug Resistant Methicillin Resistant Staphylococcus aureus Induced Pneumonia with New Antibiotic Adjuvant Entity: A Retrospective Study
Author(s)
Mohammad Shameem
Affiliation(s)
Department of Tuberculosis and Chest Disease, JN Medical College, Aligarh Muslim University, Aligarh, India.
Department of Tuberculosis and Chest Disease, JN Medical College, Aligarh Muslim University, Aligarh, India.
ABSTRACT
Aim/Objective: Increase in incidences of pneumonia due to multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA) in both community and health care settings is of great concern globally. Present study aims to retrospectively analyze the efficacy of new fixed dose combination with antibiotic adjuvant entity (FDC) in comparison with vancomycin to treat patients with multi-drug resistant MRSA pneumonia. Materials and Methods: During this retrospective study, case sheets of patients who were treated for MRSA pneumonia with vancomycin or fixed dose combination of vancomycin + ceftriaxone + adjuvant (FDC) between 20 March 2010 to 20 October 2014 at tertiary care center, were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological success was measured in terms of bacterial eradication, while clinical success was monitored in terms of complete omission of systemic signs and symptoms. Results: Among 136 patients analyzed, 113 cases were having positive culture for MRSA, and hence were further analyzed. Out of these 113 patients, empirical treatment with vancomycin was given in 59 patients and 54 patients were treated with FDC empirically. After initial culture reports, 22 patients showing resistance to vancomycin were shifted to FDC. Amidst all the patients, 24 (64.86%) of 37 from vancomycin group and 62 (81.57%) of 76 from FDC group achieved clinical success. 9 patients out of these failure cases were cured with FDC + colistin combination therapy. Failure rates in FDC treated patients were significantly low (6.57%) as compared to vancomycin group (13.51%). Conclusion: For the treatment of different types of multi-drug resistant MRSA pneumonia, the empirical intravenous FDC therapy was safe and well tolerated with higher efficacy than vancomycin. Most of the vancomycin failure cases responded to FDC therapy and were cured. This retrospective study also concludes that an alternative option of FDC + colistin is safe and effective to treat the patients which fail to respond to FDC monotherapy.
Aim/Objective: Increase in incidences of pneumonia due to multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA) in both community and health care settings is of great concern globally. Present study aims to retrospectively analyze the efficacy of new fixed dose combination with antibiotic adjuvant entity (FDC) in comparison with vancomycin to treat patients with multi-drug resistant MRSA pneumonia. Materials and Methods: During this retrospective study, case sheets of patients who were treated for MRSA pneumonia with vancomycin or fixed dose combination of vancomycin + ceftriaxone + adjuvant (FDC) between 20 March 2010 to 20 October 2014 at tertiary care center, were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological success was measured in terms of bacterial eradication, while clinical success was monitored in terms of complete omission of systemic signs and symptoms. Results: Among 136 patients analyzed, 113 cases were having positive culture for MRSA, and hence were further analyzed. Out of these 113 patients, empirical treatment with vancomycin was given in 59 patients and 54 patients were treated with FDC empirically. After initial culture reports, 22 patients showing resistance to vancomycin were shifted to FDC. Amidst all the patients, 24 (64.86%) of 37 from vancomycin group and 62 (81.57%) of 76 from FDC group achieved clinical success. 9 patients out of these failure cases were cured with FDC + colistin combination therapy. Failure rates in FDC treated patients were significantly low (6.57%) as compared to vancomycin group (13.51%). Conclusion: For the treatment of different types of multi-drug resistant MRSA pneumonia, the empirical intravenous FDC therapy was safe and well tolerated with higher efficacy than vancomycin. Most of the vancomycin failure cases responded to FDC therapy and were cured. This retrospective study also concludes that an alternative option of FDC + colistin is safe and effective to treat the patients which fail to respond to FDC monotherapy.
KEYWORDS
Pneumonia, MRSA, Multi-Drug Resistant Bacteria, Fixed Dose Combination, Retrospective Study
Pneumonia, MRSA, Multi-Drug Resistant Bacteria, Fixed Dose Combination, Retrospective Study
Cite this paper
Shameem, M. (2015) Management of Multi-Drug Resistant Methicillin Resistant Staphylococcus aureus Induced Pneumonia with New Antibiotic Adjuvant Entity: A Retrospective Study. International Journal of Clinical Medicine, 6, 784-795. doi: 10.4236/ijcm.2015.610104.
Shameem, M. (2015) Management of Multi-Drug Resistant Methicillin Resistant Staphylococcus aureus Induced Pneumonia with New Antibiotic Adjuvant Entity: A Retrospective Study. International Journal of Clinical Medicine, 6, 784-795. doi: 10.4236/ijcm.2015.610104.
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http://dx.doi.org/10.1086/340353
[1] Rubinstein, E., Kollef, M.H. and Nathwani, D. (2008) Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus. Clinical Infectious Diseases, 46, S378-S385.
http://dx.doi.org/10.1086/533594 [2] Hiramatsu, K. and Niederman, M.S. (2005) Health-Care-Associated Pneumonia: A New Therapeutic Paradigm. Chest, 128, 3784-3787.
http://dx.doi.org/10.1378/chest.128.6.3784 [3] Kollef, M.H., Shorr, A., Tabak, Y.P., Gupta, V., Liu, L.Z. and Johannes, R.S. (2005) Epidemiology and Outcomes of Health-Care-Associated Pneumonia: Results from a Large US Database of Culture-Positive Pneumonia. Chest, 128, 3854-3862.
http://dx.doi.org/10.1378/chest.128.6.3854 [4] American Thoracic Society, Infectious Diseases Society of America (2005) Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia. American Journal of Respiratory and Critical Care Medicine, 171, 388-416.
http://dx.doi.org/10.1164/rccm.200405-644ST [5] Micek, S.T., Kollef, K.E., Reichley, R.M., Roubinian, N. and Kollef, M.H. (2007) Health Care-Associated Pneumonia and Community-Acquired Pneumonia: A Single-Center Experience. Antimicrobial Agents and Chemotherapy, 51, 3568-3573.
http://dx.doi.org/10.1128/AAC.00851-07 [6] David, M.Z. and Daum, R.S. (2010) Community-Associated Methicillin-Resistant Staphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic. Clinical Microbiology Reviews, 23, 616-687.
http://dx.doi.org/10.1128/CMR.00081-09 [7] Klein, E. and Smith, D.L. (2007) Laxminarayan R: Hospitalizations and Deaths Caused by Methicillin-Resistant Staphylococcus aureus, United States, 1999-2005. Emerging Infectious Diseases Journal, 13, 1840-1846.
http://dx.doi.org/10.3201/eid1312.070629 [8] Jones, R.N. (2010) Microbial Etiologies of Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia. Clinical Infectious Diseases, 51, S81-S87.
http://dx.doi.org/10.1086/653053 [9] Kawasaki, S., Aoki, N., Kikuchi, H., Nakayama, H., Saito, N., Shimada H., et al. (2011) Clinical and Microbiological Evaluation of Hemodialysis-Associated Pneumonia (HDAP): Should HDAP Be Included in Healthcare-Associated Pneumonia? Journal of Infection and Chemotherapy, 17, 640-645.
http://dx.doi.org/10.1007/s10156-011-0228-z [10] Chastre, J. and Fagon, J.Y. (2002) Ventilator-Associated Pneumonia. American Journal of Respiratory and Critical Care Medicine, 165, 867-903.
http://dx.doi.org/10.1164/ajrccm.165.7.2105078 [11] Tablan, O.C., Anderson, L.J., Besser, R., Bridges, C. and Hajjeh, R. (2004) CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for Preventing Health-Care-Associated Pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recommendations and Reports, 53, 1-36. [12] Craven, D.E. and Steger, K.A. (1996) Nosocomial Pneumonia in Mechanically Ventilated Adult Patients: Epidemiology and Prevention in 1996. Seminars in Respiratory Infections, 11, 32-53. [13] Weinstein, R.A. (1991) Epidemiology and Control of Nosocomial Infections in Adult Intensive Care Units. American Journal of Medicine, 91, 179S-184S.
http://dx.doi.org/10.1016/0002-9343(91)90366-6 [14] Torres, A., Gatell, J.M., Aznar, E., El-Ebiary, M., Puig de la Bellacasa, J., Gonzalez, J., et al. (1995) Re-Intubation Increases the Risk of Nosocomial Pneumonia in Patients Needing Mechanical Ventilation. American Journal of Respiratory and Critical Care Medicine, 152, 137-141.
http://dx.doi.org/10.1164/ajrccm.152.1.7599812 [15] Klevens, R.M., Edwards, J.R., Richards Jr., C.L., Horan, T.C., Gaynes, R.P., Pollock, D.A., et al. (2007) Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports, 122, 160-166. [16] Shorr, A.F., Tabak, Y.P., Gupta, V., Johannes, R.S., Liu, L.Z. and Kollef, M.H. (2006) Morbidity and Cost Burden of Methicillin-Resistant Staphylococcus aureus in Early Onset Ventilator-Associated Pneumonia. Critical Care, 10, R97.
http://dx.doi.org/10.1186/cc4934 [17] Shorr, A.F., Haque, N., Taneja, C., Zervos, M., Lamerato, L., Kothari, S., et al. (2010) Clinical and Economic Outcomes for Patients with Health Care Associated Staphylococcus aureus Pneumonia. Journal of Clinical Microbiology, 48, 3258-3262.
http://dx.doi.org/10.1128/JCM.02529-09 [18] Abramson, M.A. and Sexton, D.J. (1999) Nosocomial Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Primary Bacteremia: At What Costs? Infection Control & Hospital Epidemiology, 20, 408-411.
http://dx.doi.org/10.1086/501641 [19] Carbon, C. (1999) Costs of Treating Infections Caused by Methicillin-Resistant Staphylococci and Vancomycin-Resistant Enterococci. Journal of Antimicrobial Chemotherapy, 44, 31-36.
http://dx.doi.org/10.1093/jac/44.suppl_1.31 [20] Rubin, R.J., Harrington, C.A., Poon, A., Dietrich, K., Greene, J.A. and Moiduddin, A. (1999) The Economic Impact of Staphylococcus aureus Infection in New York City Hospitals. Emerging Infectious Diseases Journal, 5, 9-17.
http://dx.doi.org/10.3201/eid0501.990102 [21] Li, J., Willke, R., Pinto, L., Rittenhouse, B.E., Rybak, M.J., Pleil, A.M., et al. (2001) Comparison of Length of Hospital Stay for Patients with Known or Suspected Methicillin-Resistant Staphylococcus Species Infections Treated with Linezolid or Vancomycin: A Randomized, Multicenter Trial. Pharmacotherapy, 21, 263-274.
http://dx.doi.org/10.1592/phco.21.3.263.34198 [22] Houck, P.M., Bratzler, D.W., Nsa, W., Ma, A. and Bartlett, J.G. (2004) Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized with Community-Acquired Pneumonia. Archives of Internal Medicine, 164, 637-644.
http://dx.doi.org/10.1001/archinte.164.6.637 [23] Rello, J., Molano, D., Villabon, M., Reina, R., Rita-Quispe, R. and Previgliano, I. (2013) Differences in Hospital- and Ventilator-Associated Pneumonia Due to Staphylococcus aureus (Methicillin-Susceptible and Methicillin-Resistant) between Europe and Latin America: A Comparison of the EUVAP and LATINVAP Study Cohorts. Medicina Intensiva, 37, 241-247.
http://dx.doi.org/10.1016/j.medin.2012.04.008 [24] Rivera, A.M. and Boucher, H.W. (2011) Current Concepts in Antimicrobial Therapy against Select Gram-Positive Organisms: Methicillin-Resistant Staphylococcus aureus, Penicillin-Resistant Pneumococci, and Vancomycin-Resistant Enterococci. Mayo Clinic Proceedings, 86, 1230-1242.
http://dx.doi.org/10.4065/mcp.2011.0514 [25] Gonzalez, C., Rubio, M., Romero-Vivas, J., Gonzalez, M. and Picazo, J.J. (1999) Bacteremic Pneumonia Due to Staphylococcus aureus: A Comparison of Disease Caused by Methicillin-Resistant and Methicillin-Susceptible Organisms. Clinical Infectious Diseases, 29, 1171-1177.
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