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Multicenter Study
. 2016 Aug 1;63(3):300-9.
doi: 10.1093/cid/ciw300. Epub 2016 May 8.

Staphylococcus aureus Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes

Wesley H Self  1 , Richard G Wunderink  2 , Derek J Williams  1 , Yuwei Zhu  1 , Evan J Anderson  3 , Robert A Balk  4 , Sherene S Fakhran  5 , James D Chappell  1 , Geoffrey Casimir  1 , D Mark Courtney  2 , Christopher Trabue  6 , Grant W Waterer  7 , Anna Bramley  8 , Shelley Magill  8 , Seema Jain  8 , Kathryn M Edwards  1 , Carlos G Grijalva  1
Affiliations
Multicenter Study

Staphylococcus aureus Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes

Wesley H Self et al. Clin Infect Dis. .

Abstract

Background: Prevalence of Staphylococcus aureus community-acquired pneumonia (CAP) and its clinical features remain incompletely understood, complicating empirical selection of antibiotics.

Methods: Using a multicenter, prospective surveillance study of adults hospitalized with CAP, we calculated the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) among all CAP episodes. We compared the epidemiologic, radiographic, and clinical characteristics of S. aureus CAP (per respiratory or blood culture) with those of pneumococcal (per respiratory or blood culture or urine antigen) and all-cause non-S. aureus CAP using descriptive statistics.

Results: Among 2259 adults hospitalized for CAP, 37 (1.6%) had S. aureus identified, including 15 (0.7%) with MRSA and 22 (1.0%) with MSSA; 115 (5.1%) had Streptococcus pneumoniae Vancomycin or linezolid was administered to 674 (29.8%) patients within the first 3 days of hospitalization. Chronic hemodialysis use was more common among patients with MRSA (20.0%) than pneumococcal (2.6%) and all-cause non-S. aureus (3.7%) CAP. Otherwise, clinical features at admission were similar, including concurrent influenza infection, hemoptysis, multilobar infiltrates, and prehospital antibiotics. Patients with MRSA CAP had more severe clinical outcomes than those with pneumococcal CAP, including intensive care unit admission (86.7% vs 34.8%) and in-patient mortality (13.3% vs 4.4%).

Conclusions: Despite very low prevalence of S. aureus and, specifically, MRSA, nearly one-third of adults hospitalized with CAP received anti-MRSA antibiotics. The clinical presentation of MRSA CAP overlapped substantially with pneumococcal CAP, highlighting the challenge of accurately targeting empirical anti-MRSA antibiotics with currently available clinical tools and the need for new diagnostic strategies.

Keywords: Staphylococcus aureus; antibiotics; pneumonia.

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Figures

Figure 1.
Figure 1.
Counts of Staphylococcus aureus and influenza community-acquired pneumonia (CAP) hospitalizations by month.
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References

    1. Francis JS, Doherty MC, Lopatin U et al. . Severe community onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentin leukocidin genes. Clin Infect Dis 2005; 40:100–7. - PubMed
    1. Hageman JC, Uyeki TM, Francis JS et al. . Severe community-acquired pneumonia due to Staphylococcus aureus, 2003–04 influenza season. Emerg Infect Dis 2006; 12:894–9. - PMC - PubMed
    1. Kallen AJ, Brunkard J, Moore Z et al. . Staphylococcus aureus community-acquired pneumonia during the 2006 to 2007 influenza season. Ann Emerg Med 2009; 53:358–65. - PubMed
    1. Kollef MH, Shorr A, Tabak YP, Gupta V, Lui LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128:3854–62. - PubMed
    1. Kollef MH, Micek ST. Staphylococcus aureus: a superbug infection in community and hospital settings. Chest 2005; 128:1093–7. - PubMed

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