Epidemiology and Outcome of Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) in Canadian Hospitals

被引：35

作者：

Tadros, Manal ^{[1
]}

Williams, Victoria ^{[2
]}

Coleman, Brenda L. ^{[1
,3
]}

McGeer, Allison J. ^{[1
,3
]}

Haider, Shariq ^{[4
]}

Lee, Christine ^{[5
]}

Iacovides, Harris ^{[6
]}

Rubinstein, Ethan ^{[6
]}

John, Michael ^{[7
]}

Johnston, Lynn ^{[8
]}

McNeil, Shelly ^{[8
]}

Katz, Kevin ^{[9
]}

Laffin, Nancy ^{[10
]}

Suh, Kathryn N. ^{[10
]}

Powis, Jeff ^{[1
,11
]}

Smith, Stephanie ^{[12
]}

Taylor, Geoff ^{[12
]}

Watt, Christine ^{[2
]}

Simor, Andrew E. ^{[1
,2
]}

机构：

[1] Univ Toronto, Toronto, ON, Canada

[2] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[3] Mt Sinai Hosp, Toronto, ON M5G 1X5, Canada

[4] Hamilton Hlth Sci Ctr, Hamilton, ON, Canada

[5] St Josephs Hlth Care, Hamilton, ON, Canada

[6] Hlth Sci Ctr, Winnipeg, MB, Canada

[7] London Hlth Sci Ctr, London, ON, Canada

[8] Queen Elizabeth 2 Hlth Sci Ctr, Halifax, NS, Canada

[9] North York Gen Hosp, Toronto, ON, Canada

[10] Ottawa Hosp, Ottawa, ON, Canada

[11] Toronto East Gen Hosp, Toronto, ON, Canada

[12] Univ Alberta Hosp, Edmonton, AB T6G 2B7, Canada

来源：

PLOS ONE | 2013年 / 8卷 / 09期

关键词：

PANTON-VALENTINE LEUKOCIDIN; COMMUNITY-ACQUIRED PNEUMONIA; NECROTIZING PNEUMONIA; CLINICAL-OUTCOMES; INFECTIONS; SURVEILLANCE; VANCOMYCIN; STRAINS; DISEASE; ADULTS;

D O I：

10.1371/journal.pone.0075171

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background: MRSA remains a leading cause of hospital-acquired (HAP) and healthcare-associated pneumonia (HCAP). We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality. Methods: Prospective surveillance for MRSA pneumonia in adults was done for one year (2011) in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP), and community-acquired pneumonia (CAP) were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE) and Panton-Valentine leukocidin (PVL) gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality. Results: A total of 161 patients with MRSA pneumonia were identified: 90 (56%) with HAP, 26 (16%) HCAP, and 45 (28%) CAP; 23 (14%) patients had VAP. The mean (+/- SD) incidence of MRSA HAP was 0.32 (+/- 0.26) per 10,000 patient-days, and of MRSA VAP was 0.30 (+/- 0.5) per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0), and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3). Conclusions: MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.

引用

页数：8

共 39 条

[1] Guidelines for the management, of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia [J].