Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Mar;245(3):397-407.
doi: 10.1097/01.sla.0000250418.14359.31.

Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit: a 9-year prospective study

Enrique Cerdá  1 , Ana Abella, Miguel A de la Cal, José A Lorente, Paloma García-Hierro, Hendrick K F van Saene, Inmaculada Alía, Ainhoa Aranguren
Affiliations

Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit: a 9-year prospective study

Enrique Cerdá et al. Ann Surg. 2007 Mar.

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.

PubMed Disclaimer

Figures

None
FIGURE 1. A, Cumulative incidence rate (acquired cases) of patients positive for MRSA (surveillance, burn wound, or diagnostic samples). B, Prevalence (imported cases) of patients positive for MRSA (surveillance, burn wound, or diagnostic samples).
None
FIGURE 2. A, Patients with acquired positive surveillance samples. B, Patients with acquired positive burn samples. C, Patients with acquired positive diagnostic samples. *Patients with acquired positive surveillance samples/total acquired samples. p25, percentile 25th; p50, median; p75, percentile 75th.
None
FIGURE 3. Cumulative risk of acquiring MRSA (Kaplan-Meier). Log rank text, P < 0.00001.
None
See this image and copyright information in PMC

References

    1. Deitch EA. The management of burns. N Engl J Med. 1990;323:1249–1253. - PubMed
    1. Pruitt BJ, McManus AT. The changing epidemiology of infection in burn patients. World J Surg. 1992;16:57–67. - PubMed
    1. O'Sullivan ST, O'Connor TPF. Immunosuppression following thermal injury: the pathogenesis of immunodysfunction. Br J Plast Surg. 1997;50:615–623. - PubMed
    1. Rue LW III, Cioffi WG, Mason AD Jr, et al. The risk of pneumonia in thermally injured patients requiring ventilatory support. J Burn Care Rehabil. 1995;16:262–268. - PubMed
    1. de la Cal MA, Cerda E, Garcia-Hierro P, et al. Pneumonia in patients with severe burns: a classification according to the concept of the carrier state. Chest. 2001;119:1160–1165. - PubMed

Publication types