Methicillin-resistant Staphylococcus aureus pneumonia in diabetics

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an important issue with significant morbidity and mortality in clinical practice, especially in diabetes mellitus (DM). Studies focusing on S. aureus pneumonia in DM is limited, we sought to make a relatively comprehensive exploration of clinical characteristics, antimicrobial resistance, and risk factors for mortality of S. aureus pneumonia in DM and non-diabetics mellitus (non-DM). Methods: A retrospective study was conducted in Ruijin Hospital from 2014 to 2017. The characteristics of DM and non-DM patients were assessed, including demographics, comorbidities, using of invasive mechanical ventilation, Hemoglobin A1c (HbA1C), confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) score, length of hospital stay, clinical outcomes, antimicrobial susceptibility. Independent risk factors for mortality were identified by univariate and multivariate logistic regression analysis. Results: A total of 365 patients with S. aureus pneumonia were included in our study, including 144 with DM and 221 non-DM. DM patients were more susceptible to MRSA infection (65.3% vs. 56.1%, P > 0.05), suffered from much severer pneumonia with a higher CURB-65 score, invasive mechanical ventilation rate (46.5% vs. 28.1%, P < 0.01) and mortality rates (30.6% vs. 23.1%, P > 0.05); almost all DM patients had higher antimicrobial resistance than non-DM patients, the DM group had a higher co-infection rate (47.2% vs. 45.7%, P > 0.05), and Acinetobacter baumannii was the most common bacterium in DM, while Klebsiella pneumoniae ranked first in patients with non-DM. Independent risk factors for pneumonia-related mortality were MRSA and CURB-65. Higher HbA1c levels were linked to a higher MRSA infection and co-infection rate and more severe pneumonia, leading to an increase in mortality. Conclusions: DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicrobial resistance, a higher co-infection rate, and much severer pneumonia than non-DM. MRSA itself is an independent risk factor for mortality in all patients.

Heparin-binding protein as a predictor of mortality in patients with diabetes mellitus and community-acquired pneumonia in intensive care unit : a propensity score matched study

“…These patients are less likely to present with acute onset, cough, purulent sputum, or pleural chest pain, [28] making the identification more challenging. In addition, DM predisposes these patients to the risk of severe CAP [29] and a poor prognosis, [10] as found in this study. The DM group had a lower PaO 2 /FiO 2 , higher rate of invasive ventilation, severe pneumonia, ARDS, SRF, and mortality during the follow-up period, which is consistent with the findings of previous studies.…”

Diabetes mellitus promotes the nasal colonization of high virulent Staphylococcus aureus through the regulation of SaeRS two-component system

“…Diabetic foot infections (DFI) are mainly polymicrobial, and Staphylococcus aureus is the most frequently isolated pathogen in diabetes-related infections [ 9–11 ]. S. aureus is a nostrious pathogen which can cause many diseases including skin and soft tissue infection, pneumonia, sepsis, etc., [ 12 ].…”

Is methicillin-resistant Staphylococcus aureus a common pathogen in ventilation-associated pneumonia?

“…[ 5 , 6 ] Patients with poor glucose control are quite susceptible to MRSA infection, being an independent risk factor for mortality. [ 7 ]…”

“…[5,6] Patients with poor glucose control are quite susceptible to MRSA infection, being an independent risk factor for mortality. [7] Approximately 10% of ventilation cases are associated with S aureus infection, with a death rate of around 50%. Deviceassociated infections in intensive care units (ICUs) are reported to increase the risk to health worldwide.…”

“…From hundreds of its various strains, Methicillin-resistant S aureus (MRSA) was defined in 1961, [4] it is considered a severe contagious pathogen causing skin infections, pneumonia, bacteremia, and other pathologies at healthcare facilities [5,6] . Patients with poor glucose control are quite susceptible to MRSA infection, being an independent risk factor for mortality [7] …”