Methicillin-resistant S. aureus ventilator-associated pneumonia: Strategies to prevent and treat

Anna P. Lam, Richard G. Wunderink*

*Corresponding author for this work

Research output: Contribution to journalReview article

16 Scopus citations

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 β-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 efficacy of-new antibiotics in MRSA VAP.

Original languageEnglish (US)
Pages (from-to)92-103
Number of pages12
JournalSeminars in Respiratory and Critical Care Medicine
Volume27
Issue number1
DOIs
StatePublished - Feb 2006

Keywords

  • Linezolid
  • Methicillin-resistance
  • Pneumonia
  • S. aureus
  • Vancomycin
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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