Group items tagged

that has continued to grow now. It approaches 60% across the United States in many of the intensive care units (ICUs)

MRSA has progressed at an average rate of about 2% over the past couple of years.

prevalence of MRSA is highly globa

areas where prevalence is fairly low -- in the Netherlands less than 1% and in Canada 2.3%

2 policies that both countries have

One is a strict search-and-destroy policy: patients from other countries and those with MRSA are isolated upon hospital admission until screening cultures for MRSA are proven negative. The second is a restrictive prescribing policy in which the defined daily dosage used per 1000 people per day in primary healthcare is around 8.9.

aureus was found to be the predominant pathogen in nosocomial skin and skin-structure infections

year 2000.

vancomycin, which is static, as well as some of the beta-lactamases

delay in appropriate treatment

resistant organisms lead to delays in appropriate treatment, and that delays in appropriate treatment lead to resistant organisms

Increased cost of MRSA

increased mortality rate associated with MRSA

vancomycin has the FDA indications, with linezolid second. Daptomycin and tigecycline are approved for skin and skin-structure infections, but quinupristin-dalfopristin is not approved for complicated skin and skin-structure infections with MRSA.

ventilator-associated pneumonia due to MRSA

surgical patients with resistant gram-positive cocci showed a higher mortality rate and increased length of stay

other studies have not found this similar association.

higher association with MRSA than with MSSA

fluoroquinolones, macrolides, previous hospitalizations, enteral feeds, surgery, and the length of stay before culture are independently associated with MRSA infections.

CA-MRSA infections

infections in the community usually manifest as skin infections, such as pimples and boils

occur in otherwise healthy people

HA-MRSA patients are in long-term care facilities, have comorbidities (such as diabetes), are on dialysis, have prolonged hospitalization, and are ICU patients

HA-MRSA is more multidrug resistant

In HA-MRSA, one sees nosocomial pneumonia, catheter-related urinary tract infections, bloodstream infections, and skin and skin-structure infections.

initially resulted from a recombination event, one involving the gene encoding in existing PBP and an inducible beta-lactamase gene.

In terms of microbiologic cure rates at the test-of-cure visit, linezolid was also superior to vancomycin.

Pharmacoeconomic analysis of this comparative trial in complicated skin and skin-structure infections showed that compared with vancomycin, linezolid reduced the length of stay and duration of IV treatment by about 2 days.

we had hardly any incidence of MRSA in the 1960s, 1970s, and 1980s in the United States

Vancomycin is IV only. It is more costly -- even as a generic, based on pharmacoeconomic data -- relative to linezolid.

Quinupristin-dalfopristin is IV only and may cause phlebitis, requiring central line placement.

Linezolid is relatively new; is more expensive (on an acquisition basis) compared with vancomycin; has reversible hematologic and, with long courses, neurologic effects; and has developed some resistance, mainly in enterococcal infections, with prolonged use and with failure to remove retained foreign bodies.

Daptomycin is IV only; quite new; has limited indications; is also expensive, compared with vancomycin; has a muscle effect requiring monitoring of creatine phosphokinase; is inactivated by surfactants, thus obviating its use in pulmonary infections; and to date has no pharmacoeconomic data.

Tigecycline is IV only, very new, and has a broader spectrum than any of the other agents in that it has some gram-negative activity

Dalbavancin is IV only, and we need to have the official data on safety, tolerance, efficacy, indication, and pharmacoeconomics, which will probably be available later this year.