scholarly journals 1301. Risk Factors for Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S738-S739
Author(s):  
Maya Bell ◽  
Courtney Veltri ◽  
Evelina Kolychev ◽  
Leila S Hojat
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Risk Factor ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Methicillin Resistant ◽  
Independent Risk Factors ◽  
The Impact

Abstract Background The 2019 American Thoracic Society and Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) guidelines concluded that the major risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) include prior isolation of these organisms and previous hospitalization with IV antibiotic use within 90 days. However, the guidelines recognized that results may vary by region and recommended local validation of risk factors. The primary objective of this study was to determine which potential risk factors are associated with MRSA and Pseudomonas aeruginosa in CAP in our institution. This study also evaluated appropriateness of antibiotics used for empiric CAP therapy. Methods This was a single-center, retrospective cohort study performed in an urban academic medical center in Cleveland, OH. Adults hospitalized for CAP who had a respiratory culture performed between January 2016 and September 2020 were included. Patients were randomized in a 1:1:1 ratio into MRSA, PsA, and non-resistant CAP (NR-CAP) groups. Patients with bacterial co-infections or resistant pathogens other than MRSA or PsA were excluded. Results The study included 111 patients with 37 patients in each group. The median age was 61 years (IQR 52-70), and 58.6% of patients were male. There were no independent risk factors for MRSA (Table 1). Independent risk factors for PsA included prior isolation and enteral feeding (Table 2). MRSA risk factors as defined by the 2019 CAP guidelines were found in 48.6% of patients with MRSA CAP (Figure 1). Guideline-defined PsA risk factors were found in 56.8% of patients with PsA CAP (Figure 2). In NR-CAP, 62.2% received empiric MRSA coverage while only 27% had a guideline-defined risk factor; PsA coverage was administered in 78.4% of NR-CAP patients, but risk factors were found in only 24.3% of this cohort. MRSA and P. aeruginosa Risk Factor Analyses Empiric MRSA and P. aeruginosa Coverage and Guideline-Defined Risk Factors Conclusion Our findings were consistent with the risk factors identified in the 2019 CAP guidelines, but additional risk factors may be present in our patient population. Empiric coverage for MRSA and PsA was disproportionately high relative to the rate of recovery. This study encourages local validation of risk factors; however, further analyses are needed to determine the impact on empiric therapy. Disclosures All Authors: No reported disclosures

Risk Factor Evaluation for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community-Acquired Pneumonia

2020 ◽  
Vol 55 (1) ◽  
pp. 36-43
Author(s):  
Paul O. Lewis
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Substance Use ◽  
Risk Factor ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
Illicit Substance Use ◽  
Local Risk

Background: The 2019 community-acquired pneumonia guidelines recommend using recent respiratory cultures and locally validated epidemiology plus risk factor assessment to determine empirical coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Objective: To develop a methodology for evaluating local epidemiology and validating local risk factors for P aeruginosa and MRSA. Methods: This multicenter, retrospective cohort evaluated adult patients admitted for pneumonia. Risk factors for MRSA and P aeruginosa were evaluated using multivariable logistic regression and reported as adjusted odds ratios (aORs). Results: There were 10 723 cases evaluated. Lung abscess/empyema had the highest odds associated with MRSA (aOR = 4.24; P < 0.0001), followed by influenza (aOR = 2.34; P = 0.01), end-stage renal disease (ESRD; aOR = 2.09; P = 0.006), illicit substance use (aOR = 1.7; P = 0.007), and chronic obstructive pulmonary disease (COPD; aOR = 1.26; P = 0.04). For P aeruginosa, the highest odds were in bronchiectasis (aOR = 6.13; P < 0.0001), lung abscess/empyema (aOR = 3.36; P = 0.005), and COPD (aOR = 1.84; P < 0.0001). Isolated COPD without other risk factors did not pose an increased risk of either organism. Conclusion and Relevance: Influenza, ESRD, lung abscess/empyema, and illicit substance use were local risk factors for MRSA. Bronchiectasis and lung abscess/empyema were risk factors for Pseudomonas. COPD was associated with MRSA and Pseudomonas. However, isolated COPD had similar rates of MRSA and Pseudomonas pneumonia compared with the total population. This study established a feasible methodology for evaluating local risk factors.

scholarly journals Multimicrobial Pneumonia during the Early Stages of a Global Pandemic

2021 ◽  
Vol 8 (6) ◽  
Author(s):  
Jalal H ◽  
◽  
Henriksen G ◽  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Acute Infection ◽  
Standard Of Care ◽  
Antibiotic Use ◽  
Lung Parenchyma ◽  
Community Acquired Pneumonia ◽  
Methicillin Resistant ◽  
Global Pandemic

Community-acquired pneumonia is an acute infection of lung parenchyma which causes local and systemic inflammatory changes via cytokines. Several bacteria and viruses are responsible for this type of pneumonia, and the most common bacterial cause is Streptococcus pneumoniae. The classic symptoms are cough, fever, and pleuritic chest pain. In the Winter of 2020, a new strain of coronavirus known as SARS-CoV-2 spread throughout the world and was responsible for a global pandemic that transformed the way we live our lives. A 93-year old female presented to the hospital with respiratory distress and was found to have not only COVID-19 pneumonia but also superimposed Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa pneumonia. Following the most up-to-date guidelines, she was determined to have community-acquired pneumonia. Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa are uncommon causes of communityacquired pneumonia. She was treated with the standard of care at the time, which included vancomycin, piperacillin-tazobactam, and hydroxychloroquine. This case highlights the rarity of this specific presentation of community acquired pneumonia in regards to microbial etiology. It showcases that patients may develop certain diseases despite not having any risk factors. A major takeaway point is that apt decision making is a critical and time sensitive matter when determining whether a bacterial co-infection is present since it can affect patient outcomes. Since co-infections are relatively infrequent, antibiotic use in COVID-19 positive patients needs to be tailored accordingly. At the same time, it is crucial to keep in mind that co-infections are associated with increased severity of COVID-19 as well as poorer outcomes.

scholarly journals Diabetic Foot Infections: Local Prevalence of and Case–Control Study of Risk Factors for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Justin J Kim ◽  
Alison Lydecker ◽  
Rohini Davé ◽  
Jacqueline T Bork ◽  
Mary-Claire Roghmann
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Control Study ◽  
Case Control ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections ◽  
Control Study

Abstract We identified deep diabetic foot infections by culture and conducted a case–control study examining the risk factors for moderate to severe methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) diabetic foot infections. Our MRSA prevalence was lower than literature values; PsA was higher. Gangrene may be predictive of Pseudomonas infection.

Methicillin-Resistant Staphylococcus aureus Infection Is a Risk Factor for Unplanned Return to the Operating Room in the Surgical Treatment of a Septic Knee

2017 ◽  
Vol 30 (09) ◽  
pp. 872-878 ◽  
Author(s):  
Timothy Costales ◽  
Patrick Greenwell ◽  
Matthew Christian ◽  
Ralph Henn ◽  
David Jaffe
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Surgical Treatment ◽  
Operating Room ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Arthroscopic Treatment ◽  
Methicillin Resistant ◽  
Open Treatment ◽  
Open Arthrotomy

AbstractSurgical irrigation and debridement is the mainstay of treatment after the diagnosis of a septic knee. Arthroscopic treatment has been validated as a treatment option, but there is limited literature comparing it to an open arthrotomy regarding risk factors for failing single-stage surgical treatment. A retrospective review of surgically treated native adult septic knees at one urban tertiary care center was conducted to evaluate rates of unplanned return to the operating room (OR) following both arthroscopic and open treatment of an adult septic knee. The primary outcome studied was unplanned return to the OR for persistent infection within 4 months of the initial surgery. Demographics, laboratory, and microbiology data were collected to identify factors associated with unplanned return visits to the OR. Fisher's exact tests and two-tailed paired Student's t-tests were used for categorical and continuous data comparisons, respectively. A multivariate analysis was performed to identify independent risk factors of initial washout failure. Thirty-three patients underwent arthroscopy and 47 had open arthrotomy. Eight failed arthroscopy and nine failed open treatment (75.8 and 80.9% success rates, p = 0.59). Unplanned repeat washouts in arthroscopically treated knees was associated with methicillin-resistant Staphylococcus aureus (MRSA) (62.5 vs. 12%, p = 0.01) and increased synovial white blood cell (WBC) count (160,000 vs. 52,000, p = 0.004). Unplanned return for repeat washout after open treatment was associated with lower American Society of Anesthesiologists scores (2.3 vs. 2.9, p = 0.019). MRSA was the only independent predictor of failure of single washout in a multivariable logistic regression analysis (p = 0.017). This study did not detect a difference in success of single washout between arthroscopic and open treatment of septic arthritis. However, MRSA was identified as a risk factor for an unplanned return to the OR after arthroscopic treatment. Consideration should be made for open surgical treatment in the setting of MRSA infections of a native knee.

Topical Therapy for Methicillin-Resistant Staphylococcus aureus Colonization Impact on Infection Risk

2009 ◽  
Vol 30 (7) ◽  
pp. 623-632 ◽  
Author(s):  
Ari Robicsek ◽  
Jennifer L. Beaumont ◽  
Richard B. Thomson ◽  
Geetha Govindarajan ◽  
Lance R. Peterson
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Antimicrobial Agents ◽  
Topical Therapy ◽  
Care Facility ◽  
Term Care ◽  
Methicillin Resistant ◽  
Mrsa Infection ◽  
Independent Risk Factors ◽  
The Impact

Objective.We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.Design.Retrospective cohort study.Setting and Intervention.Three hospitals with universal surveillance for MRSA; at their physician's discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice daily, plus Chlorhexidine gluconate 4% every second day.Patients and Methods.MRSA carriers were later retested for colonization (407 subjects; study 1) or followed up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA infection (in study 2).Results.Independent risk factors for sustained colonization included residence in a long-term care facility (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.1–3.2]) and a pressure ulcer (OR, 2.3 195% CI, 1.2–4.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy; mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6–10.7]). Over a median follow-up duration of 269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0–1.4]), chronic lung disease (HR, 1.7 [95% CI, 1.0–2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1–3.1]). Receipt of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among patients receiving mupirocin (median time to infection, 50 vs 15.5 days; P = .06).Conclusions.Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization but did not decrease the risk of subsequent infection.

scholarly journals Risk factors of methicillin-resistant Staphylococcus aureus bacteremic pneumonia in the emergency department

2022 ◽  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pleural Effusion ◽  
Chest Radiography ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Community Acquired Pneumonia ◽  
University Hospital ◽  
Methicillin Resistant ◽  
Empiric Antibiotic ◽  
Bacteremic Pneumonia

The infection rate of methicillin-resistant Staphylococcus aureus (MRSA) has increased worldwide and MRSA bacteremic pneumonia is associated with a high mortality rate. This is a retrospective study conducted at a university hospital in Korea involving adult patients diagnosed as bacteremic pneumonia caused by S. aureus in the ED between January 2009 and December 2019. We compared MRSA bacteremic pneumonia patients (n = 56) to methicillin-susceptible S. aureus bacteremic pneumonia patients (n = 49). Our study showed that that underlying hypertension (OR = 5.68; 95% CI = 2.00–16.11; p = 0.001) and cerebrovascular disease (OR = 3.54; 95% CI = 1.06–11.75; p = 0.038), recent intravenous therapy within 1 month (OR = 8.38; 95% CI = 2.88–24.38; p = 0.0001), and pleural effusion on chest radiography (OR = 5.77; 95% CI = 1.79–18.57; p = 0.003) were independent risk factors for MRSA bacteremic pneumonia presenting to the ED. Although MRSA infection has been more frequently derived from the community than before, inappropriate empiric antibiotic treatment was overwhelmingly observed in the majority of patients in our study. Considering the resistance of MRSA to the typical empiric regimen prescribed for community-acquired pneumonia, emergency physicians should pay attention to the predictors for MRSA bacteremic pneumonia including pleural effusion on chest radiography when deciding on the appropriate empiric antimicrobial therapy for pneumonia patients in the ED.

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