Predictors of the pathogenicity of methicillin-resistantStaphylococcus aureusnosocomial pneumonia

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Abstract

Background and objective:

The clinical characteristics of patients with nosocomial pneumonia (NP) associated with methicillin-resistantStaphylococcus aureus(MRSA) infection are not well characterized.

Methods:

Three hundred and thirty-seven consecutive patients with MRSA isolation from respiratory specimens who attended our hospital between April 2007 and March 2011 were enrolled. Patients characteristics diagnosed with ‘true’ MRSA-NP were described with regards to clinical, microbiological features, radiological features and genetic characteristics of the isolates. The diagnosis of ‘true’ MRSA-NP was confirmed by anti-MRSA treatment effects, Gram-staining or bronchoalveolar lavage fluid culture.

Results:

Thirty-six patients were diagnosed with ‘true’ MRSA-NP, whereas 34 were diagnosed with NP with MRSA colonization. Patients with a MRSA-NP had a Pneumonia Patient Outcomes Research Team score of 5 (58.3% vs 23.5%), single cultivation of MRSA (83.3% vs 38.2%), MRSA quantitative cultivation yielding more than 106 CFU/mL (80.6% vs 47.1%), radiological findings other than lobar pneumonia (66.7% vs 26.5%), and a history of head, neck, oesophageal or stomach surgery (30.6% vs 11.8%). These factors were shown to be independent predictors of the pathogenicity of ‘true’ MRSA-NP by multivariate analysis (P< 0.05).

Conclusions:

‘True’ MRSA-NP shows distinct clinical and radiological features from NP with MRSA colonization.

Conclusions:

Patients with a hospital-acquired ‘true’ MRSA-nosocomial pneumonia differed in severity, radiological feature and microbiological findings from patients with a hospital-acquired pneumonia with MRSA colonization. We identify several clinical factors to differentiate true MRSA nosocomial pneumonia in patients with MRSA identfification.

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