Enteral Vancomycin Controls Methicillin-resistant : A 9-Year Prospective StudyStaphylococcus Aureus: A 9-Year Prospective Study Endemicity in an Intensive Care Burn Unit: A 9-Year Prospective Study

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Abstract

Objective:

The aim of this study was to assess the efficacy and safety of enteral vancomycin in controlling MRSA endemicity in an intensive care burn unit.

Summary Background Data:

MRSA is a serious clinical and epidemiologic problem. It is not uncommon that the traditional maneuvers, detection and isolation of carriers, fail to control endemicity due to MRSA.

Methods:

All patients admitted to an Intensive Care Burn unit from January 1995 to February 2004 have been included in this prospective cohort study comprised 2 different periods. During period 1 (January 1995 to January 2000), barrier and isolation measures were enforced. During period 2 (February 2000 to February 2004), patients received enteral vancomycin 4 times daily in addition to selective digestive decontamination.

Results:

A total of 777 patients were enrolled into the study: 402 in period 1, and 375 in period 2. There were no significant differences in the characteristics of patients between the 2 periods, except for the total body surface burned area, 30.3% in period 1 and 25.61% in period 2 (P = 0.009). There was a significant reduction in the incidence of patients who acquired MRSA from 115 in period 1 to 25 in period 2 (RR, 0.22; 95% confidence interval [CI], 0.15–0.34). Similar reductions were observed in the number of patients with wound (RR, 0.20; 95% CI, 0.12–0.32), blood (RR, 0.13; 95% CI, 0.04–0.35), and tracheal aspirate (RR, 0.07; 95% CI, 0.03–0.19), samples positive for MRSA. There was no emergence of either vancomycin-resistant enterococci or Staphylococcus aureus with intermediate sensitivity to glycopeptides in period 2.

Conclusions:

Enteral vancomycin is an effective and safe method to control MRSA in intensive care burn units without VRE.

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