Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Wenisch, C; Laferl, H; Szell, M; Smolle, KH; Grisold, A; Bertha, G; Krause, R.
A holistic approach to MRSA eradication in critically ill patients with MRSA pneumonia.
Infection. 2006; 34(3):148-154
Doi: 10.1007/s15010-006-5107-7
Web of Science
PubMed
FullText
FullText_MUG
- Führende Autor*innen der Med Uni Graz
- Wenisch Christoph
- Co-Autor*innen der Med Uni Graz
- Grisold Andrea
- Krause Robert
- Smolle Karl-Heinz
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- Abstract:
- The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used. Twenty-one critically ill patients (age: 59 +/- 14 years, 15 males/6 females, 18 ventilator-associated, 3 nosocomial, clinical pulmonary infection score > 6 in all patients, APACHE II 18 +/- 5) were enrolled. The patients were treated with a 7-day course of iv linezolid (600 mg bid) plus rifampicin (600 mg bid), endotracheal vancomycin 100 mg qid, thrice daily mouth and throat washing with chlorhexidine 1% fluid and nasal mupirocin ointment, twice daily skin and hair washings with chlorhexidine gluconate 4% and tracheostomy (n = 8) wound care with povidone-iodine spray. Control samples (endotracheal secretions, nose, wound, and pharyngeal swabs) were taken 2, 3, 4, 7 days and 2 months thereafter. Multilobular pneumonia was seen in 16, pleural effusion in 12, and MRSA bacteremia in 4 patients. One patient died during the follow-up period due to cerebral bleeding. In the remaining 20 patients, pneumonia was clinically cured in all patients and all patients were free of MRSA after eradication. Six patients died due to myocardial infarction (n = 3), gram-negative septic shock (n = 2), herpes encephalitis (n = 1) > 7 days after eradication. No MRSA reinfection occurred during the control period. We conclude that in patients with MRSA pneumonia an approach using a 7-day course of intravenous linezolid plus rifampicin, intratracheal vancomycin, nasal mupirocin, cutaneous and oropharyngeal chlorhexidin plus povidone-iodine cures pneumonia and is effective for MRSA eradication.
- Find related publications in this database (using NLM MeSH Indexing)
- Acetamides -
- Aged -
- Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use
- Critical Illness -
- Cross Infection - drug therapy Cross Infection - epidemiology
- Drug Utilization - statistics & numerical data
- Female -
- Humans -
- Infection Control - methods
- Intensive Care Units - statistics & numerical data
- Linezolid -
- Male -
- Methicillin Resistance -
- Middle Aged -
- Oxazolidinones -
- Pneumonia, Staphylococcal - drug therapy
- Rifampin -
- Staphylococcal Infections - drug therapy Staphylococcal Infections - epidemiology
- Staphylococcus aureus - drug effects
- Treatment Outcome -
- Vancomycin - administration & dosage