Treatment of severe infections caused by methicillin-resistant Staphylococcus aureus in ICU

The incidence of infections caused by MRSA in ICU has decreased during the last decade. But it should be noted that great differences subsist, depending on the type of hospital and geographic location. However, in daily clinical ICU practice, the potential role of this pathogen is frequently considered in case of severe infection. If the probability is strong enough, the empirical antibiotic therapy must take this bacterium into account. MRSA is mainly involved in two diseases: bacteremia, complicated or not, and ventilator-associated pneumonia. Nowadays, the treatment of bacteremia is based on two antibiotics, vancomycin or daptomycin. For ventilator-associated pneumonia, the choice is either vancomycin or linezolid. Data comparing these drugs in these two clinical situations, their respective advantages and risks are discussed. Other antibiotics, such as gentamicin, may be associated with one of the three main antibiotics previously considered. A local policy should be defined in case of confirmed infection with a resistant strain, depending on the type of infection, its severity and presence of comorbidities such as renal failure. Determination of the MCIs of vancomycin also seems an important factor to guide this choice. Indeed, there is growing evidence of a vancomycin MIC creep in various MRSA isolates from recent publications. (C) 2013 Elsevier Masson SAS. All rights reserved.