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Severe Health Care Associated MRSA Pneumonia Has the Worst Outcomes Among All Staphylococcal Pneumonias FREE TO VIEW

Wilmary Rodriguez-Collado; Edgardo Flores Anticona; Adam Farber; Ying Fang; Shekhar Ghamande; Alejandro C Arroliga
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Texas A&M University - Baylor Scott and White Hospital, Temple, TX

Chest. 2014;146(4_MeetingAbstracts):216A. doi:10.1378/chest.1988948
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 01:30 PM - 02:30 PM

PURPOSE: There is inconsistency of results in the risk of mortality due to invasive infections by community acquired methicillin resistant Staphylococcus aureus (CA MRSA) compared to health care associated (HCAP MRSA). We compared outcomes of patients with severe CA-MRSA, HCAP-MRSA and MSSA pneumonia admitted to the ICU and study the effect of multiple variables including antibiotic choice.

METHODS: A retrospective, single center study at a teaching hospital from December 2001 until December 2012 of patients admitted to the ICU with diagnosis of MRSA or MSSA pneumonia. We used the CDC definition and the antibiotic sensitivity pattern. Patient characteristics were summarized using descriptive statistics. Logistic regression models were applied to find significant factors for mortality, MICU LOS and hospital LOS. SAS 9.2 (SAS Institute INC, Cary, NC) was used for data analysis.

RESULTS: Of 249 patients with diagnosis of severe S. aureus pneumonia, 22 (8.8%) cases were due to CA-MRSA, 120(48%) due to HCAP-MRSA and 107(42.9%) due to MSSA. The mean age in each group was 52.9 (±18.3), 60.6 (±17.1), 59.9 (±17.9) and the smoking prevalence was 11 (50.0%), 67 (57.3%) and 48 (46.2%) respectively. Groups were evenly matched for severity of illness by CURB-65 scores. Nineteen (86.4%) patients required mechanical ventilation in the CA-MRSA group, 110 (91.7%) in the HCAP-MRSA and 91 (85.0%) in the MSSA group. Multivariate analysis revealed that HCAP-MRSA patients had the highest mortality (27.4%) and ICU LOS (23.9%) compared to CA-MRSA (22.7%), (19.5%) and MSSA group (21.2%), (14.5%), (p=0.0263, p<0.0001) respectively. HCAP-MRSA patients were less likely to be discharged home (24.2%) compared to CA-MRSA (45.5%) or MSSA (42%) group, (p=0.0246). There was no significant difference in in-hospital or 1 year mortality with the use of vancomycin or linezolid, (p<0.99) and (p<0.66) respectively. 30 days readmission rate was not different in the 3 groups.

CONCLUSIONS: As compared to severe MSSA and CA-MRSA pneumonia admitted to the ICU, patients with severe HCAP-MRSA have a higher mortality and worse outcomes. Linezolid did not confer a survival benefit over vancomycin in any of the groups.

CLINICAL IMPLICATIONS: HCAP- MRSA pneumonia is associated with a higher mortality than other types of S. aureus pneumonia in the ICU.

DISCLOSURE: The following authors have nothing to disclose: Wilmary Rodriguez-Collado, Edgardo Flores Anticona, Adam Farber, Ying Fang, Shekhar Ghamande, Alejandro C Arroliga

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