title: A case of rapidly progressive necrotizing pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus.
abstract: We present the case of a patient with a necrotizing multilobar pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The patient presented with shortness of breath and a productive cough of 3 days duration. On arrival to the emergency department she was intubated for increased work of breathing and given vasopressors for hypotension refractory to fluid resuscitation. Blood cultures taken at admission, sputum cultures from the patient's endotracheal tube, and bronchoalveolar lavage cultures all grew S. aureus resistant to penicillinase-resistant penicillins. Over the following days the patient's respiratory function deteriorated as she grew progressively hypoxemic and hypercarbic despite aggressive mechanical ventilation and intravenous antibiotics. On day 4 of her hospitalization a computed tomogram revealed extensive pulmonary necrosis consistent with necrotizing pneumonia. The patient's family elected to withdraw support, and the patient rapidly died following cessation of mechanical ventilation.
authors: Department of Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Seattle Washington 98105-6920, USA. rpd4@u.washington.edu
authors: Robert P
authors: RP
authors: Dickson
authors: Shay M
authors: SM
authors: Martinez
authors: Justin R
authors: JR
authors: Ortiz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009336:Necrosis; D011023:Pneumonia, Staphylococcal / Q000473:pathology* / Q000628:therapy; D012121:Respiration, Artificial; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin