Staphylococcus aureus Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes

Wesley H Self, Richard G Wunderink, Derek J Williams, Yuwei Zhu, Evan J Anderson, Robert A Balk, Sherene S Fakhran, James D Chappell, Geoffrey Casimir, D Mark Courtney, Christopher Trabue, Grant W Waterer, Anna Bramley, Shelley Magill, Seema Jain, Kathryn M Edwards, Carlos G Grijalva, Wesley H Self, Richard G Wunderink, Derek J Williams, Yuwei Zhu, Evan J Anderson, Robert A Balk, Sherene S Fakhran, James D Chappell, Geoffrey Casimir, D Mark Courtney, Christopher Trabue, Grant W Waterer, Anna Bramley, Shelley Magill, Seema Jain, Kathryn M Edwards, Carlos G Grijalva

Abstract

Background: Prevalence of Staphylococcus aureus community-acquired pneumonia (CAP) and its clinical features remain incompletely understood, complicating empirical selection of antibiotics.

Methods: Using a multicenter, prospective surveillance study of adults hospitalized with CAP, we calculated the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) among all CAP episodes. We compared the epidemiologic, radiographic, and clinical characteristics of S. aureus CAP (per respiratory or blood culture) with those of pneumococcal (per respiratory or blood culture or urine antigen) and all-cause non-S. aureus CAP using descriptive statistics.

Results: Among 2259 adults hospitalized for CAP, 37 (1.6%) had S. aureus identified, including 15 (0.7%) with MRSA and 22 (1.0%) with MSSA; 115 (5.1%) had Streptococcus pneumoniae Vancomycin or linezolid was administered to 674 (29.8%) patients within the first 3 days of hospitalization. Chronic hemodialysis use was more common among patients with MRSA (20.0%) than pneumococcal (2.6%) and all-cause non-S. aureus (3.7%) CAP. Otherwise, clinical features at admission were similar, including concurrent influenza infection, hemoptysis, multilobar infiltrates, and prehospital antibiotics. Patients with MRSA CAP had more severe clinical outcomes than those with pneumococcal CAP, including intensive care unit admission (86.7% vs 34.8%) and in-patient mortality (13.3% vs 4.4%).

Conclusions: Despite very low prevalence of S. aureus and, specifically, MRSA, nearly one-third of adults hospitalized with CAP received anti-MRSA antibiotics. The clinical presentation of MRSA CAP overlapped substantially with pneumococcal CAP, highlighting the challenge of accurately targeting empirical anti-MRSA antibiotics with currently available clinical tools and the need for new diagnostic strategies.

Keywords: Staphylococcus aureus; antibiotics; pneumonia.

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Figures

Figure 1.
Figure 1.
Counts of Staphylococcus aureus and influenza community-acquired pneumonia (CAP) hospitalizations by month.

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