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Investigating risk factors for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in community
Philip Logan Whitfield1,2, Kristen Wendler3, Rachel Gabor4
1Department of Clinical Pharmacy Services, Marshfield Clinic Health System and Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI, USA. whitfield.philip@marshfieldclinic.org.
Background:
The 2019 American Thoracic Society and Infectious Diseases Society of America community acquired pneumonia guidelines recommend empiric coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa based on previous respiratory isolation, recent IV antibiotic use, and locally validated risk factors. This study aims to describe how local risk factors may be determined efficiently using data retrieved electronically.
Methods:
This retrospective cohort study focused on the time period May 13, 2020, through June 30, 2024. Consecutive adults admitted to one of five acute care facilities with confirmed community-acquired pneumonia were included. Community-acquired pneumonia was defined as the presence of one or more pneumonia diagnosis codes and an order for a respiratory culture or an antimicrobial with the indication of pneumonia or sepsis, 24 h before or within 48 h after the date and time of admission. Patients were excluded if they had a diagnosis code for hospital-acquired or ventilator-associated pneumonia, any subsequent admission in the study period, or if they had a previous respiratory culture positive for methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa within a year of admission. The causative pathogen and the presence or absence of evaluated risk factors were electronically abstracted from billing data and health records. Serial quality assessments of electronic data were performed to improve accuracy until a well validated population was determined.
Results:
There were 4,558 unique patients included. Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa rates were 0.6% and 0.7%, respectively. Only age was inversely associated with risk of methicillin-resistant Staphylococcus aureus (OR = 0.86, 95% CI: 0.76-0.98). No significant risk factors for Pseudomonas aeruginosa were found.
Conclusions:
In rural or otherwise resource limited healthcare settings, risk factors for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa community-acquired pneumonia may be determined using only electronic data capture and the methodology described in this article.
Insights
This study shows electronic data can efficiently identify risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in community-acquired pneumonia, aiding resource-limited settings.
Area of Science:
- Infectious Diseases
- Healthcare Informatics
- Clinical Epidemiology
Background:
- Current guidelines for community-acquired pneumonia (CAP) recommend empiric coverage for MRSA and Pseudomonas aeruginosa based on specific risk factors.
- Determining these local risk factors efficiently using electronic data is crucial for appropriate antibiotic selection.
Purpose of the Study:
- To describe an efficient method for determining local risk factors for MRSA and Pseudomonas aeruginosa in CAP using electronically retrieved data.
- To assess the utility of electronic data capture for identifying risk factors in resource-limited settings.
Main Methods:
- Retrospective cohort study of adult CAP patients across five acute care facilities (May 2020 - June 2024).
- Electronic abstraction of causative pathogens and risk factors from billing and health records.
- Exclusion of patients with hospital-acquired pneumonia, ventilator-associated pneumonia, or recent MRSA/Pseudomonas aeruginosa respiratory isolates.
Main Results:
- Analysis included 4,558 patients; MRSA and Pseudomonas aeruginosa rates were 0.6% and 0.7%, respectively.
- Only age was inversely associated with MRSA risk (OR=0.86).
- No significant risk factors were identified for Pseudomonas aeruginosa.
Conclusions:
- Electronic data capture offers an efficient method for determining local risk factors for MRSA and Pseudomonas aeruginosa in CAP.
- This approach is particularly valuable for rural or resource-limited healthcare settings.
- The study validates a methodology for risk factor assessment using readily available electronic health data.
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