Association between microbial characteristics and poor outcomes among patients with methicillin-resistant Staphylococcus aureus pneumonia: a retrospective cohort study.

McDanel JS, Perencevich EN, Diekema DJ, Winokur PL, Johnson JK, Herwaldt LA, Smith TC, Chrischilles EA, Dawson JD, Schweizer ML. Association between microbial characteristics and poor outcomes among patients with methicillin-resistant Staphylococcus aureus pneumonia: a retrospective cohort study. Antimicrobial resistance and infection control. 2015 Dec 14; 4:51.

Related HSR&D Project(s)

• CDP 13-004 – Comparative Effectiveness of Strategies to Control S. Aureus Infections (CDA 11-215)
• IIR 09-099 – Improving Practice: Automated Compliance Monitoring in Infection Control
• CDA 11-215 – Comparative Effectiveness of Strategies to Control S. aureus Infections

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Abstract:

BACKGROUND: Methicillin-resistant S. aureus (MRSA) pneumonia is associated with poor clinical outcomes. This study examined the association between microbial characteristics and poor outcomes among patients with methicillin-resistant Staphylococcus aureus pneumonia. FINDINGS: This retrospective cohort study included 75 patients with MRSA pneumonia who were admitted to two large tertiary care medical centers during 2003-2010. Multivariable models were created using Cox proportional hazards regression and ordinal logistic regression to identify predictors of mortality or increased length of stay (LOS). None of the microbial characteristics (PFGE type, agr dysfunction, SCCmec type, and detection of PVL, ACME, and TSST-1) were significantly associated with 30-day mortality or post-infection hospital length of stay, after adjusting for gender, age, previous hospital admission within 12 months, previous MRSA infection or colonization, positive influenza test, Charlson Comorbidity Index score, and treatment (linezolid or vancomycin). CONCLUSION: Large prospective studies are needed to examine the impact of microbial characteristics on the risk of death and other adverse outcomes among patients with MRSA pneumonia.