Healthcare Purchasing News - Incorrect treatment provided to one in three patients with MRSA infections
Drug-resistant, hospital-acquired infections often are treated initially with ineffective antibiotics, which increases the risk of death, according to an article in the August issue of Critical Care Medicine, the journal of the Society of Critical Care Medicine.
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The researchers conducted a three-year retrospective study of 549 Barnes-Jewish Hospital patients with MRSA sterile-site infection to determine the rate of appropriate initial antimicrobial administration and to evaluate the influence of this treatment on outcome. They found that nearly one in three MRSA-infected initially received inappropriate treatment for MRSA infection, nearly doubling their risk of death. Hospital-acquired MBSA infections have serious consequences including increases in the risk of death and in healthcare costs. Patients in intensive care units are particularly vulnerable. Hospital mortality associated with MBSA sterile-site infections is reported to be greater than 20 percent. Lead author Garrett E. Schramm, PharmD, said that it is crucial for physicians to aggressively identify and treat patients at risk for sterile-site MRSA infections and for physicians to be aware of local susceptibilities for both hospital and community-acquired MRSA isolates. “In our ICUs, we automatically treat for MRSA along with other bacteria when we have a patient with hospital-acquired infection,” said senior author Marin H. Kollef, M.D., professor of medicine at Washington University School of Medicine (St. Louis). “Obviously, not everyone will have MRSA infection, but it is so common and the consequences of not treating it upfront are so high that we treat for MRSA before its presence is confirmed.” Dr. Kollef said there are no drawbacks to including MRSA treatment in initial therapy, as long as clinicians monitor the patient. If the culture results show no evidence of MRSA infection, then MRSA-related antibiotics can be stopped. In most patients, this is done within 48 hours. Dr. Schramm says that there are a variety of antibiotics that can treat MRSA infections. Many are given intravenously and are appropriate for hospital use, while some, including sulfamethoxazole-trimethoprim (Bactrim: Roche Laboratories Inc.), can be administered orally and may be used to treat community-acquired MRSA infections. Dr. Schramm is a clinical pharmacist at Mayo Clinic in Rochester, MN, and a former critical care specialty resident at Barnes-Jewish Hospital in St. Louis.
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