Tuesday, September 29, 2009

Treatment options for nosocomial pneumonia due to MRSA.

Treatment options for nosocomial pneumonia due to MRSA.

J Infect. 2009

Department of Medicine, Winthrop University Hospital, Mineola, New York, USA. Michael S. NiedermanCorresponding Author Contact Information, a, b, E-mail The Corresponding Author

Keywords: Antibiotic resistance; Nosocomial pneumonia; Guidelines; MRSA; De-escalation therapy

Nosocomial pneumonia, which includes hospital-acquired pneumonia, ventilator-associated pneumonia, and health care associated pneumonia, remains an important cause of morbidity and mortality. The continuing emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a nosocomial pneumonia pathogen is particularly problematic not only because of its prevalence, but also because antimicrobial resistance is increasingly associated with inappropriate empirical antibiotic therapy. As a result, intensivists are faced with the dual goals of providing initial accurate broad-spectrum antibiotic coverage to reduce mortality while minimizing the risk for the emergence of antimicrobial resistance. These competing goals can be achieved by using an approach that initially delivers liberal broad-spectrum coverage followed by de-escalation once culture results and serial clinical observations become available. In ventilator-associated pneumonia, linezolid has demonstrated favorable activity against Gram-positive bacteria, including MRSA, and is recommended in evidence-based guidelines as an alternative to vancomycin, particularly when MRSA is documented as the etiology.

Elsevier/Science Direct