Risk factors of methicillin-resistant Staphylococcus aureus bacteremic pneumonia in the emergency department
1Department of Emergency Medicine, Inha University School of Medicine, 22332 Incheon, Republic of Korea
Submitted: 09 September 2021 Accepted: 14 October 2021
Online publish date: 05 January 2022
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.
Methicillin-resistant Staphylococcus aureus; Bacteremia; Pneumonia; Risk factor; Emergency department
Haesuk Jung,Youngho Seo,Seung Baik Han,Ji Hye Kim,Areum Durey. Risk factors of methicillin-resistant Staphylococcus aureus bacteremic pneumonia in the emergency department. Signa Vitae. 2022.doi:10.22514/sv.2022.003.
 Humphreys H. Staphylococcus aureus: the enduring pathogen in surgery. the Surgeon. 2012; 10: 357–360.
 Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clinical Microbiology Reviews. 2018; 31: e00020–18.
 American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal of Respiratory and Critical Care Medicine. 2005; 171: 388–416.
 David MZ, Daum RS. Community-associated methicillin resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clinical Microbiology Reviews. 2010; 23: 616–687.
 De la Calle C, Morata L, Cobos-Trigueros N, Martinez JA, Cardozo C, Mensa J, et al. Staphylococcus aureus bacteremic pneumonia. European Journal of Clinical Microbiology & Infectious Diseases. 2016; 35: 497–502.
 Rello J, Sole-Violan J, Sa-Borges M, Garnacho-Montero J, Muñoz E, Sirgo G, et al. Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides. Critical Care Medicine. 2005; 33: 1983–1987.
 Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clinical Infectious Diseases. 2003; 36: 53–59.
 Paul M, Kariv G, Goldberg E, Raskin M, Shaked H, Hazzan R, et al. Importance of appropriate empirical antibiotic therapy for methicillin-resistant Staphylococcus aureus bacteremia. Journal of Antimicrobial Chemotherapy. 2010; 65: 2658–2665.
 Watanakunakorn C. Bacteremic Staphylococcus aureus pneumonia. Scandinavian Journal of Infectious Diseases. 1987; 19: 623–627.
 González C, Rubio M, Romero-Vivas J, González M, Picazo JJ. Staphy-lococcus aureus bacteremic pneumonia: differences between community and nosocomial acquisition. International Journal of Infectious Diseases. 2003; 7: 102–108.
 DeRyke CA, Lodise TP, Rybak MJ, McKinnon PS. Epidemiology, treatment, and outcomes of nosocomial bacteremic Staphylococcus aureus pneumonia. Chest. 2005; 128: 1414–1422.
 Shorr AF, Myers DE, Huang DB, Nathanson BH, Emons MF, Kollef MH. A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia. BMC Infectious Diseases. 2013; 13: 268.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.