Topical oropharyngeal vancomycin to control methicillin resistant Staphylococcus aureus lower airway infection in ventilated patients. L. Silvestry et al . 2010. Minerva Anestesiol 76:193–202. Mark Lopez Yessenia Velazco Micr 454L 04/07/10. Objectives.
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L. Silvestry et al. 2010. Minerva Anestesiol 76:193–202
Patients over 18 years old
Required mechanical ventilation for >72 hours.
Period two (01/2004 – 06/2005) Vancomycin to all
SDD (enteral and parental antimicrobials, hygiene, and
surveillance culture of throat and rectum)
Chocolate Haemophilus, Columbia colistin-nalidixic acid plus 5% sheep
blood, and yeast agar
Significance was set at 0.05
Figure 1. Oropharyngeal carriage indices of MRSA. CI: carriage index
1. MRSA carriage treatment caused delay and promoted
overgrowth, colonization, and subsequent infection of
the lower airways
2. MRSA carriage prophylaxis protected patients against
MRSA acquisition, and MRSA found during admission
was cleared promptly by vancomycin administration.
-Epidemiological changes in frequency of MRSA in general population
-Cannot say with certainty that changes in MRSA frequency are due to vancomycin treatment
-Differing underlying medical issues may increase or decrease vulnerability to MRSA
1. Prophylactic treatment of populations with vancomycin is more effective at controlling MRSA outbreaks than treatment of individual MRSA infections.
2. Treatment with vancomycin may reduce or eliminate MRSA infections in the short term, but may cause problems in the future by encouraging more resistant forms of MRSA to develop.