title: Clinical and economic outcomes for patients with health care-associated Staphylococcus aureus pneumonia.
abstract: While the increasing importance of methicillin-resistant Staphylococcus aureus (MRSA) as a pathogen in health care-associated S. aureus pneumonia has been documented widely, information on the clinical and economic consequences of such infections is limited. We retrospectively identified all patients admitted to a large U.S. urban teaching hospital between January 2005 and May 2008 with pneumonia and positive blood or respiratory cultures for S. aureus within 48 h of admission. Among these patients, those with suspected health care-associated pneumonia (HCAP) were identified using established criteria (e.g., recent hospitalization, admission from nursing home, or hemodialysis). Subjects were designated as having methicillin-resistant (MRSA) or methicillin-susceptible (MSSA) HCAP, based on initial S. aureus isolates. Initial therapy was designated "appropriate" versus "inappropriate" based on the expected susceptibility of the organism to the regimen received. We identified 142 patients with evidence of S. aureus HCAP. Their mean (standard deviation [SD]) age was 64.5 (17) years. Eighty-seven patients (61%) had initial cultures that were positive for MRSA. Most ( approximately 90%) patients received appropriate initial antibiotic therapy (86% for MRSA versus 91% for MSSA; P = 0.783). There were no significant differences between MRSA and MSSA HCAP patients in mortality (29% versus 20%, respectively), surgery for pneumonia (22% versus 20%), receipt of mechanical ventilation (60% versus 58%), or admission to the intensive care unit (79% versus 76%). Mean (SD) total charges per admission were universally high ($98,170 [$94,707] for MRSA versus $104,121 [$91,314]) for MSSA [P = 0.712]). Almost two-thirds of patients admitted to hospital with S. aureus HCAP have evidence of MRSA infection. S. aureus HCAP, irrespective of MRSA versus MSSA status, is associated with significant mortality and high health care costs, despite appropriate initial antibiotic therapy.
authors.affiliation: Washington Hospital Center, Washington, DC, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Nadia
authors.initials: N
authors.lastname: Haque
authors.forename: Charu
authors.initials: C
authors.lastname: Taneja
authors.forename: Marcus
authors.initials: M
authors.lastname: Zervos
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.forename: Smita
authors.initials: S
authors.lastname: Kothari
authors.forename: Sophia
authors.initials: S
authors.lastname: Zilber
authors.forename: Susan
authors.initials: S
authors.lastname: Donabedian
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Perri
authors.forename: James
authors.initials: J
authors.lastname: Spalding
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D005249:Fees and Charges / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000191:economics*; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents