Enteral Vancomycin Controls Methicillin-resistant Staphylococcus Aureus Endemicity in an Intensive Care Burn Unit

In Brief 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. The aim of this prospective before-after study is to assess the efficacy and long-term safety of enteral vancomycin in controlling methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit. The study comprises a 9 year-period and 777 patients. Vancomycin was associated with a reduction of methicillin-resistant Staphylococcus aureus acquisition (RR, 0.22; 95% CI, 0.15–0.34). There were no cases of either vancomycin-resistant enterococci or Staphylococcus aureus with intermediate sensitivity to glycopeptides.