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Critical Care

, 19:312

First Online: 03 September 2015Received: 05 June 2015Accepted: 12 August 2015

Abstract

IntroductionMethicillin-resistant Staphylococcus aureus MRSA remains an important pathogen in pneumonia. Bacteremia may secondarily complicate MRSA pneumonia. The epidemiology and outcomes associated with bacteremia in the setting of MRSA pneumonia are unknown. We sought to describe the prevalence of bacteremia in MRSA pneumonia and its impact on hospital mortality and length of stay LOS.

MethodsWe conducted a single-center retrospective cohort study 2008–2013 including adult patients hospitalized with pneumonia caused by MRSA. We defined pneumonia based on clinical criteria and all cases were culture confirmed. MRSA bacteremia was identified based on positive blood cultures. Pneumonia was categorized as either community-onset CO, occurring at presentation or within 2 days of admission or hospital-onset HO, occurring > 2 days after admission. We compared bacteremic and non-bacteremic groups with respect to their demographic and clinical characteristics and outcomes. A logistic regression and a generalized linear model GLM were constructed to examine the impact of bacteremia on hospital mortality and post-pneumonia onset LOS, respectively.

ResultsAmong the 765 patients with MRSA pneumonia 33.1 % CO, 93 12.2 % had concurrent bacteremia 37.6 % CO. Patients with bacteremia were similar to non-bacteremic subjects based on demographic and clinical characteristics with the exception of frequency of a hospitalization within prior 180 days 48.4 % bacteremic and 37.7 % non-bacteremic, p = 0.047, prevalence of chronic liver disease 17.2 % vs. 9.5 %, p = 0.030, and the mean APACHE II score at the onset of pneumonia 17.5 ± 6.0 vs. 16.1 ± 6.0, p = 0.045. Both unadjusted mortality 33.7 % vs. 23.8 %, p = 0.067 and median post-pneumonia LOS 18.2 vs. 12.2 days, p < 0.001 were greater in the bacteremic than the non-bacteremic group. In a logistic regression, bacteremia showed a trend toward an association with increased mortality odds ratio 1.56, 95 % confidence interval 0.93 to 2.61. Concomitant bacteremia was independently associated with a 10.3-day increase in the post-pneumonia hospital LOS 95 % confidence interval 6.7 to 13.9 days.

ConclusionsConcurrent bacteremia occurred with moderate frequency in the setting of hospitalization with MRSA pneumonia. Although bacteremia did not appear to independently impact mortality, this was likely due to our study’s limited sample size. However, bacteremia complicating MRSA pneumonia added between 1 and 2 weeks to the hospital LOS.

AbbreviationsAICAkaike information criterion

APACHEAcute Physiology and Chronic Health Evaluation

AUROCarea under the receiver operating curve

BICBayesian information criterion

CAPcommunity-acquired pneumonia

CIconfidence interval

COcommunity-onset

CrClcreatinine clearance

GLMgeneralized linear model

HAPhospital-acquired pneumonia

HCAPhealthcare-associated pneumonia

HOhospital-onset

ICUintensive care unit

IQRinterquartile range

LOSlength of stay

M.H.K.Marin H. Kollef

MRSAmethicillin-resistant Staphylococcus aureus

USUnited States

VAPventilator-associated pneumonia

These data in part have been presented at the 2015 American Thoracic Society International Congress, Denver, CO, USA

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Author: Andrew F. Shorr - Marya D. Zilberberg - Scott T. Micek - Marin H. Kollef

Source: https://link.springer.com/







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