Empiric anti-MRSA therapy not associated with reduced mortality in pneumonia patients
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Empirical anti-MRSA therapy was not associated with reduced mortality for any group of patients hospitalized for pneumonia, even those at high risk for MRSA, according to a study published in JAMA Internal Medicine.
“Nationally, we have observed a large increase in the use of empiric, early anti-MRSA antibiotics for patients hospitalized with pneumonia, which is probably driven by an increase in the concern for resistant bugs,” Barbara Ellen Jones, MD, MSc, a pulmonary and critical care physician and health services researcher for Veterans Affairs Salt Lake City Health Care, told Healio. “Although MRSA infection is quite rare in pneumonia — found in less than 5% of patients — there is a lot of uncertainty around whether some patients who might be at high risk for MRSA would benefit from early treatment beyond standard antibiotics.”
Jones and colleagues compared 30-day mortality among 88,605 hospitalized patients who received either anti-MRSA or standard therapy for community-onset pneumonia in the Veterans Health Administration health care system between Jan. 1, 2008, and Dec. 31, 2013. They conducted the retrospective multicenter cohort study after noticing “substantial variation” in practice among hospitals and wondering whether there was a difference in patient outcomes, Jones said.
She said they failed to establish a clear benefit of anti-MRSA on 30-day mortality for any group of patients — even those who might be at higher risk for MRSA infection according to current risk approaches.
According to the findings, 33,632 patients received empirical anti-MRSA therapy. Overall, 10% of patients (n = 8,929) died within 30 days. A weighted analysis showed that empirical anti-MRSA therapy plus standard therapy was associated with an increased risk for death compared with standard therapy alone (adjusted RR [aRR] = 1.4; 95% CI, 1.3-1.5), and also an increased risk for kidney injury (aRR = 1.4; 95% CI, 1.3-1.5), secondary Clostridioides difficile infections (aRR = 1.6; 95% CI, 1.3-1.9), vancomycin-resistant Enterococcus species infections (aRR = 1.6; 95% CI, 1-2.3) and secondary gram-negative rod infections (aRR = 1.5; 95% CI, 1.2-1.8) compared with standard therapy alone.
They found similar associations between empirical anti-MRSA therapy and 30-day mortality risk among other patient groups, including those with high risk for MRSA (aRR = 1.2; 95% CI, 1.1-1.4]).
“Although there has been a trend toward using empiric anti-MRSA antibiotics for pneumonia patients, we failed to establish benefit of this practice over standard therapy for any group of patients using the current risk approaches,” Jones concluded. – by Caitlyn Stulpin
Disclosures: Jones reports no relevant financial disclosures.
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