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Is MRSA More Pathogenic in Critically Ill Patients?
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I read with great interest the recent Original Investigation "Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible [MSSA] and Methicillin-Resistant Staphylococcus aureus [MRSA]."1
The attributable mortality rates in intensive care unit (ICU) patients with staphylococcal bacteremia obtained in this study by using 2 independent case-control studies is clearly unique to this study. Even though the study did not specifically use hemodynamic instability, acute renal failure, and MRSA bacteremia as explanatory variables, it has established these statistically as independent predictors of mortality.
I would like to make the following observations in this regard:
1. It is a clear possibility that the issue of relative efficacy of penicillinase-resistant  -lactam antibiotics against MSSA bacteremias compared with that of glycopeptides against MRSA bacteremias may be magnified and become crucial in critically ill patients.
2. Perhaps the use of APACHE (Acute Physiology and Chronic Health Evaluation) II scores for critically ill . . . [Full Text of this Article]
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EXTRACT
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Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus
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ABSTRACT
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