Staphylococcus aureus Community-acquired Pneumonia

Prevalence, Clinical Characteristics, and Outcomes

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

    Research output: Contribution to journalArticle

    33 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Pages (from-to)300-309
    Number of pages10
    JournalClinical Infectious Diseases
    Volume63
    Issue number3
    DOIs
    StatePublished - Aug 1 2016

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    Staphylococcus aureus
    Pneumonia
    Methicillin-Resistant Staphylococcus aureus
    Anti-Bacterial Agents
    Linezolid
    Methicillin
    Hemoptysis
    Vancomycin
    Streptococcus pneumoniae
    Human Influenza
    Intensive Care Units
    Renal Dialysis
    Hospitalization
    Urine
    Prospective Studies
    Antigens
    Mortality

    All Science Journal Classification (ASJC) codes

    • Microbiology (medical)
    • Infectious Diseases

    Cite this

    Self, W. H., Wunderink, R. G., Williams, D. J., Zhu, Y., Anderson, E. J., Balk, R. A., ... Grijalva, C. G. (2016). Staphylococcus aureus Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes. Clinical Infectious Diseases, 63(3), 300-309. https://doi.org/10.1093/cid/ciw300

    Staphylococcus aureus Community-acquired Pneumonia : Prevalence, Clinical Characteristics, and Outcomes. / Self, Wesley H.; Wunderink, Richard G.; Williams, Derek J.; Zhu, Yuwei; Anderson, Evan J.; Balk, Robert A.; Fakhran, Sherene S.; Chappell, James D.; Casimir, Geoffrey; Courtney, D. Mark; Trabue, Christopher; Waterer, Grant W.; Bramley, Anna; Magill, Shelley; Jain, Seema; Edwards, Kathryn M.; Grijalva, Carlos G.

    In: Clinical Infectious Diseases, Vol. 63, No. 3, 01.08.2016, p. 300-309.

    Research output: Contribution to journalArticle

    Self, WH, Wunderink, RG, Williams, DJ, Zhu, Y, Anderson, EJ, Balk, RA, Fakhran, SS, Chappell, JD, Casimir, G, Courtney, DM, Trabue, C, Waterer, GW, Bramley, A, Magill, S, Jain, S, Edwards, KM & Grijalva, CG 2016, 'Staphylococcus aureus Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes', Clinical Infectious Diseases, vol. 63, no. 3, pp. 300-309. https://doi.org/10.1093/cid/ciw300
    Self, Wesley H. ; Wunderink, Richard G. ; Williams, Derek J. ; Zhu, Yuwei ; Anderson, Evan J. ; Balk, Robert A. ; Fakhran, Sherene S. ; Chappell, James D. ; Casimir, Geoffrey ; Courtney, D. Mark ; Trabue, Christopher ; Waterer, Grant W. ; Bramley, Anna ; Magill, Shelley ; Jain, Seema ; Edwards, Kathryn M. ; Grijalva, Carlos G. / Staphylococcus aureus Community-acquired Pneumonia : Prevalence, Clinical Characteristics, and Outcomes. In: Clinical Infectious Diseases. 2016 ; Vol. 63, No. 3. pp. 300-309.
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    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.",
    author = "Self, {Wesley H.} and Wunderink, {Richard G.} and Williams, {Derek J.} and Yuwei Zhu and Anderson, {Evan J.} and Balk, {Robert A.} and Fakhran, {Sherene S.} and Chappell, {James D.} and Geoffrey Casimir and Courtney, {D. Mark} and Christopher Trabue and Waterer, {Grant W.} and Anna Bramley and Shelley Magill and Seema Jain and Edwards, {Kathryn M.} and Grijalva, {Carlos G.}",
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    T1 - Staphylococcus aureus Community-acquired Pneumonia

    T2 - Prevalence, Clinical Characteristics, and Outcomes

    AU - Self, Wesley H.

    AU - Wunderink, Richard G.

    AU - Williams, Derek J.

    AU - Zhu, Yuwei

    AU - Anderson, Evan J.

    AU - Balk, Robert A.

    AU - Fakhran, Sherene S.

    AU - Chappell, James D.

    AU - Casimir, Geoffrey

    AU - Courtney, D. Mark

    AU - Trabue, Christopher

    AU - Waterer, Grant W.

    AU - Bramley, Anna

    AU - Magill, Shelley

    AU - Jain, Seema

    AU - Edwards, Kathryn M.

    AU - Grijalva, Carlos G.

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    N2 - 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.

    AB - 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.

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