Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals.
BACKGROUND
MRSA remains a leading cause of hospital-acquired (HAP) and healthcare-associated pneumonia (HCAP). We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality.


METHODS
Prospective surveillance for MRSA pneumonia in adults was done for one year (2011) in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP), and community-acquired pneumonia (CAP) were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE) and Panton-Valentine leukocidin (PVL) gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality.


RESULTS
A total of 161 patients with MRSA pneumonia were identified: 90 (56%) with HAP, 26 (16%) HCAP, and 45 (28%) CAP; 23 (14%) patients had VAP. The mean (± SD) incidence of MRSA HAP was 0.32 (± 0.26) per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5) per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0), and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3).


CONCLUSIONS
MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.
University of Toronto, Toronto, Ontario, Canada.
Manal
M
Tadros
Victoria
V
Williams
Brenda L
BL
Coleman
Allison J
AJ
McGeer
Shariq
S
Haider
Christine
C
Lee
Harris
H
Iacovides
Ethan
E
Rubinstein
Michael
M
John
Lynn
L
Johnston
Shelly
S
McNeil
Kevin
K
Katz
Nancy
N
Laffin
Kathryn N
KN
Suh
Jeff
J
Powis
Stephanie
S
Smith
Geoff
G
Taylor
Christine
C
Watt
Andrew E
AE
Simor
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011023:Pneumonia, Staphylococcal / Q000453:epidemiology*; D011446:Prospective Studies; D062486:Public Health Surveillance; D055815:Young Adult