WEDNESDAY, Jan. 19 (HealthDay News) -- Intensive care patients
who may be infected with strains of pneumonia that are resistant to
many drugs may be more likely to die if current treatment
guidelines are followed, a new study suggests.
The findings highlight the need to reassess the American
Thoracic Society (ATS) and the Infectious Diseases Society of
America (IDSA) guidelines, said the researchers.
Current guidelines call for immediate antibiotic treatment --
before culture results are known -- of patients at risk for
multiple drug-resistant (MDR) infection. The guidelines state that
patients should receive a regimen of three antibiotics: two drugs
against so-called Gram-negative pathogens and one drug against
Staphylococcus aureus, or MRSA. The logic in this approach is that at least one drug should be active against any likely infectious agent.
However, several studies conducted since the guidelines were
released in 2005 have failed to show that dual Gram-negative
therapy is better than treatment with a single drug, the
For their study, a team led by Dr. Daniel Kett, of the
University of Miami Miller School of Medicine, enrolled 303
patients at risk for MDR pneumonia from four academic medical
centers in the United States. Of those patients, 129 were treated
according to the ATS/IDSA guidelines and 174 received a different
The rate of survival after 28 days was 65 percent in the
guidelines-compliant group and 79 percent in the group that didn't
adhere to the guidelines, the investigators found.
"Our results further question the need for combination Gram-negative empirical treatment for patients with pneumonia, even those who are severely ill and at risk of multi-drug resistant pathogens," the researchers wrote.
One expert was not surprised by the findings.
"Who gets pneumonia with resistant bacteria? It is a person in such weakened condition that they are vulnerable to pathogens that would otherwise be trivial," noted Dr. Bruce Hirsch, attending physician in the infectious diseases division at North Shore University Hospital in Manhasset, N.Y. "It is a person who has suffered multiple infections already and has been exposed to multiple courses of antibiotics. It is a person with structural lung abnormalities that prevent the lungs from recovering from infections."
According to Hirsch, the new study "demonstrates high mortality
rates in patients given recommended antibiotics as well as
individualized antibiotics. Even in this age of sophisticated and
powerful medications, adherence to the best guidelines can fail
For their part, the study authors "recommend that the planned,
revised ATS-IDSA guidelines be reassessed before widespread
implementation. Since the most common reason for non-compliance was
failure to use a secondary anti-Gram-negative drug, we suggest a
comparison of regimens employing MRSA treatment and single versus
dual Gram-negative coverage."
The study was published in the Jan. 19 online edition of
The Lancet Infectious Diseases.
The American Lung Association has more about