<i>Staphylococcus aureus</i>Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes

Self, Wesley H.; Wunderink, Richard G.; Williams, Derek J.; Zhu, Yuwei; Anderson, Evan J.; Balk, R.A.; Fakhran, Sherene; Chappell, James D.; Casimir, G.; Courtney, D. Mark; Trabue, Christopher; Waterer, Grant; Bramley, Anna M.; Magill, Shelley S.; Jain, Seema; Edwards, Kathryn M.; Grijalva, Carlos G.

doi:10.1093/cid/ciw300

Cited by 155 publications

(152 citation statements)

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“…While MRSA remains a significant concern in patients who develop pneumonia while hospitalized and even more so while mechanically ventilated, MRSA as a causative pathogen in patients admitted for pneumonia is uncommon (1,2,14,15). Jones and colleagues demonstrated a rate of MRSA-associated pneumonia of 2.0% to 2.5% over a 5-year period (2).…”

Section: Discussionmentioning

confidence: 99%

“…espite a relatively low prevalence, methicillin-resistant Staphylococcus aureus (MRSA) remains an important pathogen in considering empirical antibiotic therapy for patients hospitalized with pneumonia (1)(2)(3). The most recent iteration of the Infectious Diseases Society of America (IDSA) guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) recommend empirical coverage of MRSA in patients with intravenous antibiotic exposure in the past 90 days, hospitalization at an institution with Ͼ20% of S. aureus isolates identified as MRSA, or in patients at high risk of mortality (e.g., need for mechanical ventilation or presence of shock) (4).…”

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confidence: 99%

“…As a result of these challenges, the most common culture obtained is a sputum culture, which often lacks reliability as a proper sputum sample requires deep expectoration (8,9). Furthermore, even if a respiratory culture is obtained, a causative pathogen may not be recovered (1,7). Thus, despite the uncommon incidence of MRSA pneumonia, MRSA-targeted antibiotics are often started and potentially continued for prolonged periods due to a lack of objective microbiology data allowing for de-escalation (1).…”

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confidence: 99%

“…Furthermore, even if a respiratory culture is obtained, a causative pathogen may not be recovered (1,7). Thus, despite the uncommon incidence of MRSA pneumonia, MRSA-targeted antibiotics are often started and potentially continued for prolonged periods due to a lack of objective microbiology data allowing for de-escalation (1).…”

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confidence: 99%

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Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia

Baby

Faust

Smith

et al. 2017

Antimicrob Agents Chemother

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The objective of this study was to evaluate the impact of pharmacistordered methicillin-resistant Staphylococcus aureus (MRSA) PCR testing on the duration of empirical MRSA-targeted antibiotic therapy in patients with suspected pneumonia. This is a retrospective analysis of patients who received vancomycin or linezolid for suspected pneumonia before and after the implementation of a pharmacist-driven protocol for nasal MRSA PCR testing. Patients were included if they were adults of Ͼ18 years of age and initiated on vancomycin or linezolid for suspected MRSA pneumonia. The primary endpoint was the duration of vancomycin or linezolid therapy. After screening 368 patients, 57 patients met inclusion criteria (27 pre-PCR and 30 post-PCR). Baseline characteristics were similar between the two groups, with the majority of patients classified as having health care-associated pneumonia (68.4%). The use of the nasal MRSA PCR test reduced the mean duration of MRSA-targeted therapy by 46.6 h (74.0 Ϯ 48.9 h versus 27.4 Ϯ 18.7 h; 95% confidence interval [CI], 27.3 to 65.8 h; P Ͻ 0.0001). Fewer patients in the post-PCR group required vancomycin serum levels and dose adjustment (48.1% versus 16.7%; P ϭ 0.02). There were no significant differences between the pre-and post-PCR groups regarding days to clinical improvement (1.78 Ϯ 2.52 versus 2.27 Ϯ 3.34; P ϭ 0.54), length of hospital stay (11.04 Ϯ 9.5 versus 8.2 Ϯ 7.8; P ϭ 0.22), or hospital mortality (14.8% versus 6.7%; P ϭ 0.41). The use of nasal MRSA PCR testing in patients with suspected MRSA pneumonia reduced the duration of empirical MRSA-targeted therapy by approximately 2 days without increasing adverse clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia

Baby

Faust

Smith

et al. 2017

Antimicrob Agents Chemother

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“…Additionally, smokers are at greater risk of being colonized with antibiotic resistance S. aureus (MRSA) than nonsmokers. This finding is of note because MRSA infections have higher morbidity and mortality than methicillin-sensitive strains [20,21]. Accumulating evidence suggests that this susceptibility to MRSA/staphylococcal infection may reflect not only the impairment of host defenses induced by chronic exposure to cigarette smoke, but also provirulent changes in commensal MRSA itself as a consequence of the same chronic cigarette smoke exposure.…”

Section: Introductionmentioning

confidence: 97%

Effects of Electronic (e)-Cigarette Vapor on Staphylococcal Virulence: Are E-Cigarettes Safer than Conventional Cigarettes?

Alexander¹,

Enany²,

McEachern³

2017

Frontiers in Staphylococcus Aureus

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In recent years, electronic (e)-cigarettes have dramatically increased in popularity as an alternative to conventional cigarettes. Little is known about the effects of e-cigarette vapor (EV) on bacteria that colonize the nasopharynx, including methicillin-resistant Staphylococcus aureus (MRSA). As most cases of pneumonia can be traced to bacteria in a patient's nasopharynx, increased virulence in potential pathogens could have direct consequences clinically for these patients. And because bacterial colonizers are spread between humans, increased virulence in one subject has implications for the community. There is accumulating evidence that exposure to cigarette smoke (CS) increases the pathogenicity of MRSA, as well as its dampening effects on the host immune system. EV exposure has also been demonstrated to increase MRSA virulence both in vitro and in a murine model of pneumonia. In this chapter, we will compare the virulence changes reported in MRSA exposed to CS vs. those exposed to EV, as well as proposed mechanisms and therapeutic targets.

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Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Gohil,

Septimus,

Kleinman

et al. 2024

JAMA

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ImportancePneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non–critically ill patients admitted with pneumonia.Design, Setting, and ParticipantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non–critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020.InterventionCPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (&lt;10%) of MDRO pneumonia, coupled with feedback and education.Main Outcomes and MeasuresThe primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies.ResultsAmong 59 hospitals with 96 451 (51 671 in the baseline period and 44 780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; P &lt; .001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups.Conclusions and RelevanceEmpiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged.Trial RegistrationClinicalTrials.gov Identifier: NCT03697070

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Staphylococcus aureusCommunity-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes

Cited by 155 publications

References 44 publications

Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia

Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia

Effects of Electronic (e)-Cigarette Vapor on Staphylococcal Virulence: Are E-Cigarettes Safer than Conventional Cigarettes?

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

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