Risk Factor Evaluation for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa in
1Johnson City Medical Center, Johnson City, TN, USA.
Background:
The 2019 community-acquired pneumonia guidelines recommend using recent respiratory cultures and locally validated epidemiology plus risk factor assessment to determine empirical coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa.
Objective:
To develop a methodology for evaluating local epidemiology and validating local risk factors for P aeruginosa and MRSA.
Methods:
This multicenter, retrospective cohort evaluated adult patients admitted for pneumonia. Risk factors for MRSA and P aeruginosa were evaluated using multivariable logistic regression and reported as adjusted odds ratios (aORs).
Results:
There were 10 723 cases evaluated. Lung abscess/empyema had the highest odds associated with MRSA (aOR = 4.24; P < 0.0001), followed by influenza (aOR = 2.34; P = 0.01), end-stage renal disease (ESRD; aOR = 2.09; P = 0.006), illicit substance use (aOR = 1.7; P = 0.007), and chronic obstructive pulmonary disease (COPD; aOR = 1.26; P = 0.04). For P aeruginosa, the highest odds were in bronchiectasis (aOR = 6.13; P < 0.0001), lung abscess/empyema (aOR = 3.36; P = 0.005), and COPD (aOR = 1.84; P < 0.0001). Isolated COPD without other risk factors did not pose an increased risk of either organism.
Conclusion And Relevance:
Influenza, ESRD, lung abscess/empyema, and illicit substance use were local risk factors for MRSA. Bronchiectasis and lung abscess/empyema were risk factors for Pseudomonas. COPD was associated with MRSA and Pseudomonas. However, isolated COPD had similar rates of MRSA and Pseudomonas pneumonia compared with the total population. This study established a feasible methodology for evaluating local risk factors.
Insights
This study identified key risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa pneumonia, including lung abscesses and end-stage renal disease. This helps guide empirical antibiotic coverage based on local epidemiology.
Area of Science:
- Infectious Diseases
- Pulmonology
- Clinical Epidemiology
Background:
- The 2019 community-acquired pneumonia guidelines advocate for empirical antibiotic coverage decisions based on local epidemiology and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa.
- A validated methodology is needed to assess local epidemiology and specific risk factors for these pathogens.
Purpose of the Study:
- To develop and validate a methodology for evaluating local epidemiology and risk factors associated with MRSA and P. aeruginosa in pneumonia patients.
- To identify specific clinical factors that predict the presence of MRSA or P. aeruginosa in community-acquired pneumonia.
Main Methods:
- A multicenter, retrospective cohort study involving 10,723 adult pneumonia admissions.
- Multivariable logistic regression analysis was employed to identify risk factors for MRSA and P. aeruginosa, with results reported as adjusted odds ratios (aORs).
Main Results:
- Lung abscess/empyema, influenza, end-stage renal disease (ESRD), illicit substance use, and chronic obstructive pulmonary disease (COPD) were associated with MRSA.
- Bronchiectasis, lung abscess/empyema, and COPD were associated with P. aeruginosa.
- Isolated COPD did not increase the risk for either pathogen.
Conclusions:
- Influenza, ESRD, lung abscess/empyema, and illicit substance use are significant local risk factors for MRSA pneumonia.
- Bronchiectasis and lung abscess/empyema are key risk factors for P. aeruginosa pneumonia.
- COPD is associated with both pathogens, but isolated COPD does not confer increased risk, highlighting the importance of specific risk factor assessment for targeted empirical therapy.
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