Current problems in the diagnosis and treatment of hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia.
OBJECTIVE
We aimed evaluate clinical problems in the diagnosis and treatment of hospital-associated pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA-HAP) at a single institute.


METHODS
Forty-two patients, diagnosed with MRSA-HAP by a primary physician, who had received antimicrobial therapy during a period of 18 consecutive months at University Hospital, Kyoto Prefectural University of Medicine, were enrolled in the study. For comparison, 36 patients in whom MRSA was recovered from the respiratory tract during the same period, but who were not treated for pneumonia, were chosen as untreated controls. A clinical pulmonary infection score (CPIS) was calculated retrospectively by a chart review. The CPIS was calculated on day 1 and day 3. In the treated group, serum concentrations of each therapeutic drug used were also evaluated.


RESULTS
The day-1 and day-3 CPIS showed a similar trend in the two at groups, at 2.5 +/- 1.8 and 3.9 +/-1.9, respectively, in the treated group and 2.9 +/- 1.9 and 3.8 +/- 1.6 in the control group. Only two (5%) patients in the treated group showed a CPIS of more than 6 on day 1. Only five patients (12%) in the treated group were treated with antimicrobials at appropriate target therapeutic serum concentrations. The 30-day mortality in the treated group was significantly higher than that in the control group, even when we matched the baseline morbidity of patients using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.


CONCLUSIONS
This study revealed the clinical problems in our setting, in that MRSA colonization in the respiratory tract was frequently treated as pneumonia, and antimicrobial dosage was frequently insufficient. Prudent differential diagnosis of and treatment for HAP due to MRSA infection should be considered.
Sakaguchi
Masahiro
M
Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital, Otsu, Japan.
Shime
Nobuaki
N
Fujita
Naohisa
N
Fujiki
Sakiko
S
Hashimoto
Satoru
S
D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome