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Community‐acquired methicillin‐resistant Staphylococcus aureus pneumonia: A clinical audit
Author(s) -
THOMAS RAJESH,
FERGUSON JOHN,
COOMBS GEOFFREY,
GIBSON PETER G
Publication year - 2011
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2011.01965.x
Subject(s) - medicine , community acquired pneumonia , empyema , pneumonia , methicillin resistant staphylococcus aureus , medical record , retrospective cohort study , surgery , mechanical ventilation , staphylococcus aureus , genetics , biology , bacteria
Background and objective: Community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) strains are primarily associated with skin and soft tissue infections; however, they are increasingly causing more invasive infections including severe community‐acquired pneumonia. The objective of this study was to describe the clinico‐pathological characteristics of community‐acquired MRSA pneumonia. Methods: A retrospective analysis of case records from January 2002 to August 2008 was performed on patients admitted with community‐acquired MRSA pneumonia to two large teaching hospitals. Results: Sixteen patients with community‐acquired MRSA pneumonia were identified. Their age ranged from 11 months to 86 years (median age; 30 years). Duration of symptoms before hospital presentation ranged from one to 21 days. Most patients had productive cough, fever and dyspnoea. The most common radiological presentation included multilobar consolidation (8/16), necrotizing consolidation (7/16) and empyema (5/16). Seven patients required intensive care support; four required ionotropic support and five required mechanical ventilation for a mean duration of 53 h and 6.6 days, respectively. Six patients underwent surgery (VATS or open thoracotomy). There was a mean delay of approximately 69 h (range; 18 h to 11 days) after presentation before appropriate MRSA antimicrobial treatment was initiated. Three patients died of complications from pneumonia, all within 72 h of presentation. Among survivors, the average length of hospital stay was 23.8 days (range; 10–49 days). Majority of survivors were left with mild residual radiological changes. Conclusions: Community‐acquired MRSA pneumonia is increasing and should be suspected in patients with severe community‐acquired pneumonia. There was a delay in initiation of appropriate antimicrobial treatment that could have lead to increased morbidity.