Clinical

Empirical anti-MRSA therapy does not improve mortality in patients with pneumonia


 

Background: Empirical broad-spectrum antibiotics including anti-MRSA therapy are often selected because of concerns for resistant organisms. However, the outcomes of empirical anti-MRSA therapy among patients with pneumonia are unknown.

Dr. Ting Li,  is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.

Dr. Ting Li


Study design: A national retrospective multicenter cohort study of hospitalizations for pneumonia.

Setting: This cohort study included 88,605 hospitalizations for pneumonia in the Veterans Health Administration health care system during 2008-2013, in which patients received either anti-MRSA or standard therapy for community-onset pneumonia.

Synopsis: Among 88,605 hospitalizations for pneumonia, 38% of the patients received empirical anti-MRSA therapy within the first day of hospitalization and vancomycin accounted for 98% of the therapy. The primary outcome was 30-day all-cause mortality after adjustment for patient comorbidities, vital signs, and laboratory results. Three treatment groups were studied: patients receiving anti-MRSA therapy (vancomycin hydrochloride or linezolid) plus guideline-recommended standard antibiotics (beta-lactam and macrolide or tetracycline hydrochloride, or fluoroquinolone); patients receiving anti-MRSA therapy without standard antibiotics; and patients receiving standard therapy alone. There was no mortality benefit of empirical anti-MRSA therapy versus standard antibiotics, even in those with risk factors for MRSA or in those whose clinical severity warranted admission to the ICU. Empirical anti-MRSA treatment was associated with greater 30-day mortality compared with standard therapy alone, with an adjusted risk ratio of 1.4 (95% confidence interval, 1.3-1.5) versus empirical anti-MRSA treatment plus standard therapy and 1.5 (1.4-1.6) versus empirical anti-MRSA treatment without standard therapy.

Bottom line: Empirical anti-MRSA therapy does not improve mortality and should not be routinely used in patients hospitalized for community-onset pneumonia, even in those with MRSA risk factors.

Citation: Jones BE et al. Empirical anti-MRSA vs. standard antibiotic therapy and risk of 30-day mortality in patients hospitalized for pneumonia. JAMA Intern Med. 2020 Feb 17;180(4):552-60.

Dr. Li is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.

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