Yonsei Med J.  2014 Jul;55(4):967-974. 10.3349/ymj.2014.55.4.967.

Comparison of Methicillin-Resistant Staphylococcus aureus Community-Acquired and Healthcare-Associated Pneumonia

• Leem AY
• Jung WJ
• Kang YA
• Park SC
• Kim YJ
• Hwang ED
• Kim EY
• Jung KS
• Park MS
• Kim SY
• Kim YS
• Kim SK
• Chang J
• Jung JY

• KMID: 2130821
• DOI: http://doi.org/10.3349/ymj.2014.55.4.967

Abstract

PURPOSE
Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only healthcare-associated pneumonia (HCAP) but also community-acquired pneumonia (CAP). We determined the impact of MRSA on differences in clinical characteristics, courses, and outcomes between CAP and HCAP.
MATERIALS AND METHODS
We conducted a retrospective observational study on 78 adult patients admitted with MRSA pneumonia at a university-affiliated tertiary hospital between January 2008 and December 2011. We compared baseline characteristics, chest radiographs, treatment outcomes, and drug resistance patterns between the CAP and HCAP groups.
RESULTS
Of the 78 patients with MRSA pneumonia, 57 (73.1%) were HCAP and 21 (26.9%) were CAP. MRSA infection history in the previous year (29.8% vs. 14.3%, p=0.244) tended to be more common in HCAP than in CAP. Despite similar Pneumonia Severity Index scores (151 in CAP vs. 142 in HCAP), intubation rates (38.1% vs. 17.5%; p=0.072) and intensive care unit admission (42.9% vs. 22.8%; p=0.095) tended to be higher in the CAP group, while 28-day mortality was higher in the HCAP group (14.3% vs. 26.3%; p=0.368), although without statistical significance. All patients showed sensitivity to vancomycin and linezolid; meanwhile, HCAP patients showed greater resistance to gentamicin than CAP patients (58.3% vs. 16.6%; p=0.037). The median total hospital charges were 6899 American dollars for CAP and 5715 American dollars for HCAP (p=0.161).
CONCLUSION
MRSA pneumonia showed significantly differences in baseline characteristics, chest radiographs, treatment outcomes, and medical expenses between HCAP and CAP groups.

Keyword

Pneumonia; methicillin-resistant Staphylococcus aureus; community-acquired pneumonia; healthcare-associated pneumonia

MeSH Terms

Aged
Community-Acquired Infections/*microbiology
Female
Humans
Male
Methicillin-Resistant Staphylococcus aureus/*pathogenicity
Middle Aged
Pneumonia/*microbiology
Retrospective Studies

Figure

• 

  Fig. 1 Proportion of MRSA culture-positive community-acquired pneumonia and healthcare-associated pneumonia from 2008 to 2011. The proportions of MRSA in culture-positive CAP and HCAP in each year were as follows: 7% (6/86) and 10.1% (8/79) in 2008, 2.9% (3/105) and 7.6% (8/105) in 2009, 3.0% (4/133) and 19.4% (21/108) in 2010, and 4.7% (8/172) and 12.9% (20/155) in 2011, respectively. CAP, community-acquired pneumonia; HCAP, healthcare-associated pneumonia; MRSA, methicillin-resistant Staphylococcus aureus.

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