Impact of empiric anti-MRSA therapy on survival outcome in severe acute pancreatitis: a MIMIC-IV cohort study.

OBJECTIVE

To evaluate the impact of early empirical anti-Methicillin-resistant Staphylococcus aureus (MRSA) therapy on the survival outcomes of patients with severe acute pancreatitis (SAP) in the intensive care units (ICUs).

DESIGN

Secondary Analysis of the the Medical Information Mart for Intensive Care-IV (MIMIC-IV v3.1) on MRSA therapy in Intensive Care Units (ICUs).

SETTING

94,458 ICU hospitalization records from 65,366 unique patients between 2008 and 2019.

PATIENTS: 494 patients diagnosed with acute pancreatitis first admitted to the ICU.

INTERVENTIONS: Anti-MRSA (vancomycin or linezolid) agents.

MAIN VARIABLES OF INTEREST: 28-day and 90-day mortality rates, incidence of renal impairment, and total hospitalization costs.

RESULTS

A total of 494 patients were included, 302 (61.1%) patients received anti-MRSA therapy. After PSM, no significant differences were observed in ICU mortality (adjusted relative risk [aRR], 0.39; 95% CI, 0.11-1.38, p = 0.14) or hospital mortality (aRR, 0.53; 95% CI, 0.21-1.33, p = 0.18) between the two groups. Similarly, 28-day mortality and 90-day mortality did not significantly differ (p > 0.05). Empirical anti-MRSA therapy was associated with significantly longer ICU and hospital LOS (p < 0.001). Subgroup analysis revealed that anti-MRSA therapy significantly increased acute kidney injury incidence (p = 0.002), particularly in patients without pre-existing kidney disease (p < 0.001).

CONCLUSIONS

Empirical anti-MRSA therapy was not associated with improved short- or long-term survival in SAP patients, and may lead to prolonged ICU and hospital stays. These findings highlight the importance of integrating local MRSA epidemiology into antimicrobial stewardship decisions.