Alfa Institute of Biomedical Sciences, Athens, Greece.
Int J Tuberc Lung Dis. 2009 Dec;13(12):1476-85.
To investigate the clinical features and prognosis of patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) producing the Panton-Valentine leukocidin (PVL).
PubMed and Scopus were searched. Inclusion was stratified according to S. aureus susceptibility and clinical, microbiological and outcome data of patients with S. aureus CAP; both primary and secondary cases of CAP (hematogenous spread from other sites of infection) were included.
We identified 71 articles reporting data on patients with MRSA (n = 76) and MSSA (n = 31) PVL-positive CAP. There were no differences in demographics and history among patients with MRSA and MSSA CAP. Features associated with MRSA CAP were gastrointestinal tract symptoms (P = 0.016) and unilobar infiltrates (P = 0.043). Features associated with MSSA CAP were airway hemorrhage (P = 0.01), multilobar infiltrates (P = 0.043) and acute respiratory distress syndrome (ARDS, P = 0.023). Although MSSA patients were more likely to receive initial appropriate antimicrobial therapy (P < 0.001), there was no difference in mortality between the two groups (P = 0.919). Univariate analysis showed that influenza-like symptoms (P < 0.001), multi-organ failure (P < 0.001), admission to the intensive care unit (P < 0.001), mechanical ventilation (P < 0.001), leucopenia (P < 0.001), shock (P = 0.001), development of complications (P = 0.003), vein thrombosis (P < 0.001), disseminated intravascular coagulation (P = 0.03), acidosis (P = 0.012), rash (P = 0.024), ARDS (P = 0.021), necrotizing pneumonia (P = 0.026), and use of macrolides after culture results (P = 0.011) were factors associated with death.
Patients with MRSA PVL-positive CAP did not have higher rates of mortality than patients with MSSA PVL-positive CAP.
研究产杀白细胞素金黄色葡萄球菌（PVL）的耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）社区获得性肺炎（CAP）患者的临床特征和预后。
在 PubMed 和 Scopus 上进行检索。根据金黄色葡萄球菌的敏感性和金黄色葡萄球菌 CAP 患者的临床、微生物学和结局数据进行分层纳入，包括原发性和继发性 CAP（血源播散自其他感染部位）。
我们共确定了 71 篇报道了产 PVL 的 MRSA（n = 76）和 MSSA（n = 31）CAP 患者数据的文章。MRSA 和 MSSA CAP 患者的人口统计学和病史无差异。MRSA CAP 相关特征为胃肠道症状（P = 0.016）和单侧浸润（P = 0.043）。MSSA CAP 相关特征为气道出血（P = 0.01）、多肺叶浸润（P = 0.043）和急性呼吸窘迫综合征（ARDS，P = 0.023）。尽管 MSSA 患者更有可能接受初始适当的抗菌治疗（P < 0.001），但两组死亡率无差异（P = 0.919）。单因素分析显示流感样症状（P < 0.001）、多器官功能衰竭（P < 0.001）、入住重症监护病房（P < 0.001）、机械通气（P < 0.001）、白细胞减少（P < 0.001）、休克（P = 0.001）、并发症发生（P = 0.003）、静脉血栓形成（P < 0.001）、弥漫性血管内凝血（P = 0.03）、酸中毒（P = 0.012）、皮疹（P = 0.024）、ARDS（P = 0.021）、坏死性肺炎（P = 0.026）和培养结果后使用大环内酯类药物（P = 0.011）与死亡相关。
产 PVL 的 MRSA CAP 患者的死亡率不比产 PVL 的 MSSA CAP 患者高。
