Community-acquired Pneumonia with Methicillin-resistant Staphylococcus Aureus in a Patient Admitted to the Intensive Care Unit: A Therapeutic Challenge

Background. Pneumonia is the most common cause of morbidity and mortality in developing countries, mostly caused by different species of bacterial pathogens. Hence, patient management needs awareness of the pathogens and antimicrobial susceptibility testing (AST). This study was aimed to assess the type of bacterial isolates and their antimicrobial susceptibility patterns among pneumonia suspected patients at Dessie Referral Hospital, Northeast Ethiopia. Potential risk factors were also assessed to apply preventive measures accordingly. Materials and Methods. A cross-sectional study design was employed among pneumonia suspected patients from February to April 2020 at Dessie Referral Hospital. Sociodemographic characteristics and associated risk factors were collected using a pretested questionnaire, and clinical data were extracted by reviewing medical records. Sputum specimens were collected and inoculated into chocolate agar, blood agar, mannitol salt agar, and MacConkey agar which are then incubated at 35°C or 37°C for 24–48 hours. Bacterial species were identified based on Gram stain, colony characteristics, and biochemical techniques. The data were entered in to Epi-Info version 7.1.5 and analyzed with SPSS software version 20. p value <0.05 at 95% CI was considered as statistically significant. Results. A total of 406 sputum specimens were collected and cultured, among which 157 (38.7%) were positive for different bacterial pathogens. The predominant pathogens were Klebsiella pneumoniae (28.0%), Streptococcus pneumoniae (24.8%), Staphylococcus aureus (18.5%), and Pseudomonas aeruginosa (14.0%). Majority of the isolates exhibited resistance to ampicillin with 81.5% followed by penicillin with 75.9% and amoxicillin-clavulanate with 61.2%. Multivariable logistic regression showed a significant association of culture positivity with older age (AOR = 2.43, CI: 1.12–5.28, p value = 0.025), cigarette smoking (AOR = 4.67, CI: 2.39–9.20, p value <0.001), and alcohol use (AOR = 5.58, CI: 3.14–9.92, p value <0.001). Resistance to ampicillin and penicillin was associated with repeated prescription and use. Conclusions. This study found high prevalence of bacterial pneumonia in the study area, and high rate of bacterial resistance was observed in ampicillin, penicillin, and amoxicillin-clavulanate. Repeated prescriptions and use of antimicrobials were significantly independent factors of bacterial resistance. Therefore, patient management needs identification of bacteria by routine culture with antimicrobial susceptibility testing.

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“…is indicates that MRSA is becoming an important pneumonia-causing pathogen in the study area and supported by other studies [12,53,54].…”

Section: Discussionsupporting

confidence: 84%

Multiresistant Bacterial Pathogens Causing Bacterial Pneumonia and Analyses of Potential Risk Factors from Northeast Ethiopia

Dessie

Jemal

Maru

et al. 2021

International Journal of Microbiology

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“…have previously been implicated in nosocomial cases although a recent report revealed community-acquired -MRS pneumonia, particularly CA-MRSA. 47 The low resistance of Staphylococcus species to GEN and CIP in this study indicated that these could be a useful alternative for treatment in cases where first-line antibiotics represent a failure. An Ethiopian study reported similar findings.…”

Section: Discussionmentioning

confidence: 68%

Molecular Characterization of Multidrug-resistant Bacteria Isolated From Patients With Pneumonia at Two Hospitals in North-West Nigeria

Oyegoke

Olayinka

Ehinmidu

et al. 2021

Int J Epidemiol Res

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Background and aims: The spread of antimicrobial resistance (AMR) is a serious public health threat complicating treatment and resulting in prolonged hospitalization. The prevalence of AMR threat is not well defined due to the dearth of appropriate surveillance systems. This study sought to assess the prevalence of AMR among bacterial isolates from sputum specimens obtained from patients with pneumonia presenting at two secondary healthcare facilities in Zaria from June 1 to August 31, 2018. Methods: Standard methodology was followed in processing sputum samples that met the acceptance criteria. The antibiotic susceptibility patterns of bacterial pathogens cultured from sputum specimens obtained from June 1 to August 31, 2018) were evaluated using the recommendation of the Clinical and Laboratory Standards Institute. Finally, data were analyzed using descriptive statistics. Results: Acinetobacter spp. were the predominant pathogens accounting for 32% of recovered isolates, followed by Staphylococcus spp. (18%) and Klebsiella spp. (17%), respectively. AMR was found in 91% of the isolates. Most isolates were resistant to erythromycin (ERY) (80%) and amoxicillin (83.3%). Eventually, the multiple antibiotic resistance index ≥0.3 was observed in 76% of the isolates. Conclusion: Based on the findings, AMR rates were observed to be high, and may display a serious therapeutic challenge to the management of community-acquired pneumonia. Concerted efforts are needed to combat the worrisome AMR trends revealed in this study.

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“…4 Lethality of MRSA CAP is believed to originate from Panton-Valentin-Leukocidin (PVL) toxin produced by MRSA causing leukocytes death and subsequently significant lung necrosis and lethal pneumonia. [3][4][5] In a study by Bhatta et al reported PVL-positive in 90.4 % of community -acquired MRSA, whereas only 7.1% of hospital-acquired MRSA were PVL-positive, suggesting that PVL may be a marker of community-acquired MRSA. 6 The incidence of MRSA CAP is undetermined yet.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 However, linezolid has been favorably suggested as a better alternative to vancomycin as it has a better lung penetration, with almost 100% oral bioavailability, and does not need dose adjustment or frequent level monitoring comparing to vancomycin. 3,4 Several studies recommended a rapid test for early identification of MRSA to avoid the overuse of anti-MRSA antibiotics which may lead to antibiotics resistance, increased cost, and clostridium difficile infections. 9 We herein report an uncommon case of severe MRSA CAP who presented with altered mental status and septic shock in a previously healthy old male.…”

Section: Discussionmentioning

confidence: 99%

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MRSA Community-acquired Pneumonia: Non COVID-19 Related Bilateral Ground-glass Opacities

Alfraji¹

2021

Biom Case Rep Open A Open J

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Methicillin-resistant staph aureus (MRSA) has been known to cause severe hospital-acquired infections with its multi-drug resistant nature. MRSA Infections could quickly escalate into severe sepsis resulting in death, if not recognized and treated abruptly. This pathogen uncommonly causes Community-Acquired Pneumonia (CAP), which can lead to under treatment due to delayed coverage with anti-MRSA antibiotics resulting in poor clinical outcome. We herein describe an unusual case of MRSA CAP during COVID-19 pandemic in an 80-year-old male who was unresponsive and found to be in septic shock, intubated outside the hospital setting, and then brought to intensive care unit for further management. Laboratory and radiographic studies revealed MRSA in sputum culture and extensive bilateral consolidation with bilateral ground glass opacities and pleural effusions on imaging. Our patient was successfully treated with linezolid and extubated within 48 hours with a favorable outcome. High index of suspicion and a timely coverage with anti-MRSA antibiotics would reduce mortality and lead to a better outcome in otherwise fatal infection. Keywords: MRSA; Community-acquired pneumonia; Respiratory failure; Critical care; Case report

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Community-acquired Pneumonia with Methicillin-resistant Staphylococcus Aureus in a Patient Admitted to the Intensive Care Unit: A Therapeutic Challenge

Cited by 8 publications

References 8 publications

Multiresistant Bacterial Pathogens Causing Bacterial Pneumonia and Analyses of Potential Risk Factors from Northeast Ethiopia

Multiresistant Bacterial Pathogens Causing Bacterial Pneumonia and Analyses of Potential Risk Factors from Northeast Ethiopia

Molecular Characterization of Multidrug-resistant Bacteria Isolated From Patients With Pneumonia at Two Hospitals in North-West Nigeria

MRSA Community-acquired Pneumonia: Non COVID-19 Related Bilateral Ground-glass Opacities

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