دورية أكاديمية
أعرض في EDS

Predictors of clinical success among a national Veterans Affairs cohort with methicillin-resistant Staphylococcus aureus pneumonia.

التفاصيل البيبلوغرافية
العنوان: Predictors of clinical success among a national Veterans Affairs cohort with methicillin-resistant Staphylococcus aureus pneumonia.
المؤلفون: Caffrey AR; Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, Rhode Island; University of Rhode Island, College of Pharmacy, Kingston, Rhode Island., Morrill HJ; Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, Rhode Island; University of Rhode Island, College of Pharmacy, Kingston, Rhode Island., Puzniak LA; Pfizer Inc, Collegeville, Pennsylvania., LaPlante KL; Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, Rhode Island; University of Rhode Island, College of Pharmacy, Kingston, Rhode Island; Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island. Electronic address: kerrylaplante@uri.edu.
المصدر: Clinical therapeutics [Clin Ther] 2014 Apr 01; Vol. 36 (4), pp. 552-9. Date of Electronic Publication: 2014 Mar 14.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Excerpta Medica Country of Publication: United States NLM ID: 7706726 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-114X (Electronic) Linking ISSN: 01492918 NLM ISO Abbreviation: Clin Ther Subsets: MEDLINE
أسماء مطبوعة: Publication: 1998- : Belle Mead, NJ, : Excerpta Medica
Original Publication: Princeton, N. J., Excerpta Medica.
مواضيع طبية MeSH: Methicillin-Resistant Staphylococcus aureus* , Veterans*, Anti-Bacterial Agents/*therapeutic use , Linezolid/*therapeutic use , Pneumonia, Staphylococcal/*drug therapy , Vancomycin/*therapeutic use, Aged ; Case-Control Studies ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Pneumonia, Staphylococcal/microbiology ; Treatment Outcome ; United States
مستخلص: Background: The treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is exceedingly complicated, which is concerning because of the high mortality rate associated with the infection. Identification of independent predictors of clinical success can optimize patient care by assisting clinicians in treatment decisions.
Objectives: Our goal was to identify independent predictors of clinical success in a national Veterans Affairs (VA) cohort of patients with MRSA pneumonia.
Methods: A nested case-control study was conducted among a cohort of VA patients with MRSA pneumonia receiving linezolid or vancomycin between January 2002 and September 2010. Cases included those demonstrating clinical success, defined as discharge from the hospital or intensive care unit by day 14 after treatment initiation, in the absence of death, therapy change, or intubation by day 14. Control subjects represented nonsuccess, defined as therapy change, intubation, intensive care unit admission, readmission, or death between treatment initiation and day 14. The potential predictors assessed included treatment, patient demographic and admission characteristics, previous health care and medication exposures, comorbidities, and medical history. Odds ratios (ORs) and 95% CIs were calculated from logistic regression.
Results: Our study included 2442 cases of clinical success and 1290 control subjects. Demographic characteristics varied between the clinical success and nonsuccess groups, including age, race, and region of facility. A current diagnosis of chronic respiratory disease (46% vs 42%) and diagnosis of pneumonia in the year before the MRSA pneumonia admission (37% vs 32%) were both more common in the clinical success group. Despite these significant differences, only 2 predictors of clinical success were identified in our study: previous complication of an implant or graft, including mechanical complications and infections, in the year before the MRSA pneumonia admission (adjusted OR, 1.55 [95% CI, 1.17-2.06]) and treatment with linezolid (adjusted OR, 1.53 [95% CI, 1.12-2.10]). Predictors of nonsuccess (adjusted OR [95% CI) included diagnosis of concomitant urinary tract infection (0.82 [0.70-0.96]), intravenous line (0.76 [0.66-0.89]), previous coagulopathy (0.74 [0.56-0.96]), previous amputation procedure (0.72 [0.53-0.98]), current coagulopathy diagnosis (0.71 [0.53-0.96]), dialysis (0.54 [0.38-0.76]), multiple inpatient procedures (0.53 [0.45-0.62]), inpatient surgery (0.48 [0.41-0.57]), and previous endocarditis (0.24 [0.07-0.81]).
Conclusions: MRSA pneumonia tends to affect patients with complex care, and identification of the predictors of clinical success is useful when considering different therapeutic approaches. In this national cohort of VA patients with MRSA pneumonia, treatment was the only modifiable variable predicting clinical success.
(Published by EM Inc USA.)
فهرسة مساهمة: Keywords: linezolid; methicillin-resistant Staphylococcus aureus; pneumonia; predictors of clinical success; vancomycin
المشرفين على المادة: 0 (Anti-Bacterial Agents)
6Q205EH1VU (Vancomycin)
ISQ9I6J12J (Linezolid)
تواريخ الأحداث: Date Created: 20140318 Date Completed: 20160115 Latest Revision: 20181202
رمز التحديث: 20240829
DOI: 10.1016/j.clinthera.2014.02.013
PMID: 24631473
قاعدة البيانات: MEDLINE
الوصف
تدمد:1879-114X
DOI:10.1016/j.clinthera.2014.02.013