Prevalence of Methicillin-Resistant Staphylococcus aureus as an Etiology of Community-Acquired Pneumonia

Gregory J Moran; Anusha Krishnadasan; Rachel J Gorwitz; Greg E Fosheim; Valerie Albrecht; Brandi Limbago; David A Talan; EMERGEncy ID NET Study Group

doi:10.1093/cid/cis022

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Prevalence of Methicillin-Resistant Staphylococcus aureus as an Etiology of Community-Acquired Pneumonia

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Prevalence of Methicillin-Resistant Staphylococcus aureus as an Etiology of Community-Acquired Pneumonia

Gregory J Moran, Anusha Krishnadasan, Rachel J Gorwitz, Greg E Fosheim, Valerie Albrecht, Brandi Limbago, David A Talan and EMERGEncy ID NET Study Group

Clinical infectious diseases, Vol.54(8), pp.1126-1133

04/15/2012

DOI: 10.1093/cid/cis022

PMID: 22438343

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Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon cause of community-acquired pneumonia (CAP), accounting for only 2.4% of cases among 627 patients hospitalized for CAP through emergency departments in the United States in 2006–2007. Those with an MRSA etiology appeared to be more seriously ill. (See the Editorial Commentary by Mandell and Wunderink, on pages 1134–6.) Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infections. Recent case series describe severe community-acquired pneumonia (CAP) caused by MRSA, but the prevalence and risk factors are unknown. Methods. We prospectively enrolled adults hospitalized with CAP from 12 university-affiliated emergency departments during the winter–spring of 2006 and 2007. Clinical information and culture results were collected, and factors associated with MRSA were assessed. Results. Of 627 patients, 595 (95%) had respiratory (50%) and/or blood cultures (92%) performed. A pathogen was identified in 102 (17%); MRSA was identified in 14 (2.4%; range by site, 0%–5%) patients and in 5% of patients admitted to the intensive care unit. Two (14%) MRSA pneumonia patients died. All 9 MRSA isolates tested were pulsed-field type USA300. Features significantly associated with isolation of MRSA (as compared with any other or no pathogen) included patient history of MRSA; nursing home admission in the previous year; close contact in the previous month with someone with a skin infection; multiple infiltrates or cavities on chest radiograph; and comatose state, intubation, receipt of pressors, or death in the emergency department. Conclusions. Methicillin-resistant Staphylococcus aureus remains an uncommon cause of CAP. Detection of MRSA was associated with more severe clinical presentation.

Details

Title: Subtitle: Prevalence of Methicillin-Resistant Staphylococcus aureus as an Etiology of Community-Acquired Pneumonia
Creators: Gregory J Moran - Olive View-UCLA Medical Center
Anusha Krishnadasan - Royal College of Emergency Medicine
Rachel J Gorwitz - National Center for Emerging and Zoonotic Infectious Diseases
Greg E Fosheim - National Center for Emerging and Zoonotic Infectious Diseases
Valerie Albrecht - National Center for Emerging and Zoonotic Infectious Diseases
Brandi Limbago - National Center for Emerging and Zoonotic Infectious Diseases
David A Talan - Olive View-UCLA Medical Center
EMERGEncy ID NET Study Group
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.54(8), pp.1126-1133
DOI: 10.1093/cid/cis022
PMID: 22438343
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Publisher: Oxford University Press
Language: English
Date published: 04/15/2012
Academic Unit: Emergency Medicine; Internal Medicine
Record Identifier: 9984296967002771

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