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Correspondence |

Staphylococcus aureus in Community-Acquired Pneumonia FREE TO VIEW

Kristoffer Strålin, MD, PhD; Bo Söderquist, MD, PhD
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Örebro University Hospital Örebro, Sweden

Correspondence to: Kristoffer Strålin, MD, PhD, Department of Infectious Diseases, Örebro University Hospital, SE-70185 Örebro, Sweden; e-mail, kristoffer.stralin@orebroll.se



Chest. 2006;130(2):623. doi:10.1378/chest.130.2.623
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To the Editor:

We are concerned about the frequencies of bacterial pathogens in patients with culture-positive community-acquired pneumonia (CAP) that were reported by Kollef et al (December 2005).1 Among 2,221 such patients, Staphylococcus aureus was identified in 25.5% of patients, Streptococcus pneumoniae was identified in 16.6% of patients, and Haemophilus influenzae was identified in 16.6% of patients.

From November 1999 to October 2003, 668 patients who were hospitalized in our department had a discharge code of pneumonia, chest radiograph infiltrates, and no hospitalization during the preceding month. Among 191 patients (median age, 68 years) with culture-positive CAP (ie, significant bacterial pathogens identified by blood culture [n = 60] and/or sputum culture), S pneumoniae was identified in 57% (n = 109; 46 bacteremic cases), H influenzae was identified in 27% (n = 51; 3 bacteremic cases), and S aureus was identified in 7.3% (n = 14; 5 bacteremic cases). This frequency of S aureus is consistent with the level of 2.9% in seven previous studies of hospitalized CAP patients that were summarized by Marrie.2 In our opinion, the frequencies of bacterial pathogens reported by Kollef et al1 are too odd to support the guideline recommendations for CAP.

In the pneumonia population in the study by Kollef et al,1S aureus was the only pathogen that was associated with increased mortality. Among our CAP patients detailed above, death within 30 days occurred in 29% of the 14 patients with S aureus identified (n = 4; one bacteremic case), compared with 5.1% of the 177 other patients with culture-positive CAP (n = 9; nine bacteremic cases; p = 0.009 [Fisher exact test]). Severe necrotizing pneumonia can be caused by S aureus carrying the Panton-Valentine leukocidin gene.,3However, S aureus isolates from three of our patients who died were tested and were negative for the Panton-Valentine leukocidin gene.4

Since S aureus is an uncommon cause of CAP, it does not need to be covered by the empirical CAP treatment. However, the severity associated with S aureus pneumonia reinforces the importance of performing routine blood and respiratory cultures in pneumonia patients.

Drs, Strålin and Söderquist have no conflicts of interest to disclose.

Kollef, MH, Shorr, A, Tabak, YP, et al (2005) Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia.Chest128,3854-3862
 
Marrie, TJ Etiology of community-acquired pneumonia. Marrie, TJ eds.Community-acquired pneumonia2001,131-141 Kluwer Academic/Plenum Publishers. New York, NY:
 
Gillet, Y, Issartel, B, Vanhems, P, et al Association betweenStaphylococcus aureusstrains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients.Lancet2002;359,753-759
 
Johnsson, D, Mölling, P, Strålin, K, et al Detection of Panton-Valentine leukocidin gene inStaphylococcus aureusby LightCycler PCR: clinical and epidemiological aspects.Clin Microbiol Infect2004;10,884-889
 

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References

Kollef, MH, Shorr, A, Tabak, YP, et al (2005) Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia.Chest128,3854-3862
 
Marrie, TJ Etiology of community-acquired pneumonia. Marrie, TJ eds.Community-acquired pneumonia2001,131-141 Kluwer Academic/Plenum Publishers. New York, NY:
 
Gillet, Y, Issartel, B, Vanhems, P, et al Association betweenStaphylococcus aureusstrains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients.Lancet2002;359,753-759
 
Johnsson, D, Mölling, P, Strålin, K, et al Detection of Panton-Valentine leukocidin gene inStaphylococcus aureusby LightCycler PCR: clinical and epidemiological aspects.Clin Microbiol Infect2004;10,884-889
 
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