Staphylococcus aureus pneumonia in neonates: clinical patterns, laboratory findings and outcomes

Staphylococcus aureus (SA) pneumonia is a leading cause of neonatal morbidity and mortality, particularly with methicillin-resistant Staphylococcus aureus (MRSA). Despite its prevalence, limited studies have focused on clinical presentation, antimicrobial resistance patterns, and outcomes of SA pneumonia in neonates. This study aimed to explore the clinical features, laboratory findings, and outcomes of neonates with SA pneumonia at the National Children's Hospital, Vietnam.

We conducted a retrospective observational study on 31 neonates diagnosed with SA pneumonia from January 2022 to June 2023. Clinical data, including demographic details, symptoms, white blood cell (WBC) count, C-reactive protein (CRP) levels, antimicrobial susceptibility, and radiological findings, were collected. We analyzed the antibiotic resistance patterns of SA and evaluated factors associated with vancomycin treatment failure.

Of the 31 neonates, 96.8 % were diagnosed with MRSA pneumonia. The main clinical symptoms were fever (77.4 %), tachypnea (83.9 %), and chest retraction (80.6 %). SA was primarily isolated from endotracheal fluid (71.0 %), pleural fluid (41.9 %), and both combined (51.6 %) with positive blood cultures. Complications were common, with pleural effusion in 54.8 %, pneumothorax in 48.4 %, necrotizing pneumonia in 25.8 %, and lung abscess in 29.0 % of cases. Vancomycin was the primary antibiotic administered, though treatment failure occurred in 38.7 % of cases, necessitating alternative antibiotics, particularly in patients with severe illness requiring mechanical ventilation, vasopressor support, and elevated CRP levels (>15 mg/L). Most strains were resistant to beta-lactam antibiotics but sensitive to vancomycin, linezolid, ciprofloxacin, and levofloxacin. The average hospital stay was 24.4 ± 12.6 days, with a mortality rate of 12.9 %, mainly due to severe respiratory failure and septic shock.

These findings highlight the critical importance of early diagnosis, optimized antibiotic therapy, and careful monitoring to reduce complications and improve survival outcomes in neonates with SA pneumonia.