Methicillin-Resistant S. aureus Ventilator-Associated Pneumonia: Strategies to Prevent and Treat

Seminars in Respiratory and Critical Care Medicine
Anna P Lam, R G Wunderink

Abstract

Ventilator-associated pneumonias (VAPs) due to methicillin-resistant Staphylococcus aureus (MRSA) are rising in incidence and pose unique challenges in their prevention and treatment. Risk factors for the development of MRSA VAP include nasal carriage, prior antibiotic therapy, prolonged mechanical ventilation, poor infection control practices, head trauma/coma, and viral infection. Measures to prevent the development of MRSA VAP include general VAP prevention strategies and reduction of S. aureus nasal carriage. S. aureus possesses a variety of transferable genetic elements that encode proteins conferring resistance to several antibiotics, including beta-lactams and glycopeptides. Successful treatment of MRSA VAP with currently available antibiotics has been poor. Current management guidelines recommend glycopeptides as initial therapy for MRSA VAP. However vancomycin success rates are low, ranging from only 35 to 57%. This may be due to the poor penetration of vancomycin into the lung, and alternate dosing regimens to increase tissue levels need to be further studied. Treatment with linezolid, which penetrates well into the lung, is associated with higher cure and survival rates. Further data are needed to evaluate the effica...Continue Reading

Citations

Oct 29, 2011·Medicina clínica·Julián Torre-CisnerosManuel Casal Román
Nov 11, 2008·Disease-a-month : DM·Mark D Johnson, Catherine F Decker
Sep 26, 2008·Nursing in Critical Care·Patrick Turton
Mar 27, 2010·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·M DrydenA Voss
Apr 4, 2007·Expert Review of Anti-infective Therapy·Federico Pea, Pierluigi Viale

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