Reduction in rates of methicillin-resistant Staphylococcus aureus infection after introduction of quarterly linezolid-vancomycin cycling in a surgical intensive care unit.
Reduction in rates of methicillin-resistant Staphylococcus aureus infection after introduction of quarterly linezolid-vancomycin cycling in a surgical intensive care unit.
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在外科重症监护室引入每季度利奈唑胺-万古霉素循环后，耐甲氧西林金黄色葡萄球菌感染率降低。
DOI：
10.1089/sur.2007.024
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发表时间：
2008
影响因子：
2
通讯作者：
Sawyer,RobertG
中科院分区：
文献类型：
--
作者：
Smith,RobertL;Evans,HeatherL;Chong,TaeW;McElearney,ShannonT;Hedrick,TraciL;Swenson,BrianR;Scheld,WMichael;Pruett,TimothyL;Sawyer,RobertG
Background: The burden of infection with antibiotic-resistant gram-positive cocci, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE), continues to increase, leading to substantial morbidity and high mortality rates, particularly in intensive care units (ICUs). Creative interventions may be required to reverse or stabilize this trend.Methods: The efficacy of empiric cycling of antibiotics active against gram-positive organisms was tested in a before–after intervention in a single surgical ICU. Four years of baseline data were compared with two years of data compiled after the implementation of a strategy where the empiric antibiotic of choice for the treatment of gram-positive infections (linezolid or vancomycin) was changed every three months. Whatever the initial choice of drug, if possible, the antibiotic was de-escalated after final culture results were obtained. The rates of all gram-positive infections were analyzed, with a particular focus on MRSA and VRE. Concurrently, similar outcomes were followed for patients treated on the same services but outside the ICU, where cycling was not practiced.Results: During the four years prior to cycling, 543 infections with gram-positive organisms were acquired in the ICU (45.3/1,000 patient-days), including 105 caused by MRSA (8.8/1,000 patient days) and 21 by VRE (1.8/1,000 patient-days). In the two years after implementation of cycling, 169 gram-positive infections were documented (28.1/1,000 patient-days; p < 0.0001 vs. non-cycling period), including 11 caused by MRSA (1.8/1,000 patient-days; p < 0.0001 vs. non-cycling period). The percentage ofS. aureusinfections caused by MRSA declined from 67% to 36%. The rate of infection with VRE was unchanged. Outside the ICU, the yearly numbers of infections with both MRSA and VRE increased over time.Conclusion: Quarterly cycling of linezolid and vancomycin in the ICU is a promising method to reduce infections with MRSA.
