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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e318282630e
Original Articles

Methicillin-Resistant Staphylococcus aureus Pneumonia: What is the Optimal Duration of Treatment?

Zainah, Hadeel MD*; Nakhleh, Rasha MD; Hassan, Syed MD; Arshad, Samia MPH*; Zervos, Marcus MD*

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Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with high morbidity and mortality. There is no consensus about the length of therapy. Current Infectious Diseases Society of America consensus guidelines recommend 7 to 21 days for duration.

Methods: In a retrospective study conducted in a 900-bed teaching hospital in urban Detroit over a 26-month period, we evaluated the charts of 706 patients with positive MRSA respiratory cultures. We studied 115 patients with MRSA pneumonia.

Results: The mean ± SD age for the patients was 64.36 ± 14.44 years; 67 patients (58.77 %) were women, 44 patients (38.26%) had multilobar pneumonia. Patients were treated with either vancomycin or linezolid or treatment was switched between those 2 agents. The mean ± SD treatment duration was 13.1 ± 7.1 days. The overall 28-day mortality rate was 28.73% (n = 32). Among the 83 patients who survived to 28 days, 9 patients (10.8%) received treatment for less than 8 days, 33 patients (39.8%) received treatment for 8 to 13 days, 26 patients (31.3%) received treatment for 14 to 20 days, and 15 patients (18.1%) received treatment for more than 20 days. Among the 32 patients who did not survive to 28 days, 11 patients (34.4%) received treatment for less than 8 days, 14 patients (43.8%) received treatment for 8 to 13 days, 6 patients (18.8%) received treatment for 14 to 20 days, and 1 patient (3.1%) received treatment for more than 20 days; P < 0.001.

Conclusion: The nonsurvivors were treated for shorter durations than survivors, indicating that MRSA pneumonia requires longer treatment durations (≥14 days).

© 2013 by Lippincott Williams & Wilkins.

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