Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
BMC Infect Dis. 2013 Aug 9;13:370. doi: 10.1186/1471-2334-13-370.
Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only hospital acquired pneumonia, but also non-nosocomial pneumonia. However, the risk factors for non-nosocomial MRSA pneumonia are not clearly defined. Our objective was to identify risk factors at admission that were associated with non-nosocomial MRSA pneumonia.
We evaluated 943 patients admitted to a university-affiliated hospital with culture-positive bacterial pneumonia developed outside the hospital from January 2008 to December 2011. We compared the clinical characteristics between MRSA and non-MRSA pneumonia, and identified risk factors associated with MRSA pneumonia.
Of 943 patients, MRSA was identified in 78 (8.2%). Higher mortality was observed in MRSA than in non-MRSA patients (33.3% vs. 21.5%; P = 0.017). In a logistic regression analysis, MRSA pneumonia was observed more frequently in patients with a previous history of MRSA infection (OR = 6.05; P < 0.001), a PSI score ≥120 (OR = 2.40; P = 0.015), intravenous antibiotic treatment within 30 days of pneumonia (OR = 2.23; P = 0.018). By contrast, non-MRSA pneumonia was observed more often in patients with a single infiltrate on chest radiography (OR = 0.55; P = 0.029).
Anti-MRSA antibiotics could be considered in hospitalized non-nosocomial patients with several risk factors identified herein. The presence or absence of these factors would provide useful guidance in selecting initial empirical antibiotics.
耐甲氧西林金黄色葡萄球菌（MRSA）不仅是医院获得性肺炎的重要病因，也是社区获得性肺炎的重要病因。然而，社区获得性 MRSA 肺炎的危险因素尚不清楚。我们的目的是确定与社区获得性 MRSA 肺炎相关的入院时的危险因素。
我们评估了 2008 年 1 月至 2011 年 12 月期间在一所大学附属医院住院的 943 例患有社区获得性细菌性肺炎的患者。我们比较了 MRSA 肺炎与非 MRSA 肺炎的临床特征，并确定了与 MRSA 肺炎相关的危险因素。
943 例患者中，MRSA 感染 78 例（8.2%）。MRSA 肺炎患者的死亡率高于非 MRSA 肺炎患者（33.3% vs. 21.5%；P = 0.017）。Logistic 回归分析显示，既往有 MRSA 感染史（OR = 6.05；P < 0.001）、PSI 评分≥120（OR = 2.40；P = 0.015）、肺炎发病前 30 天内静脉应用抗生素（OR = 2.23；P = 0.018）的患者更容易发生社区获得性 MRSA 肺炎。相反，胸部 X 线片仅有单个浸润影的患者更容易发生非 MRSA 肺炎（OR = 0.55；P = 0.029）。
对于存在本研究确定的多个危险因素的住院非医院获得性肺炎患者，可以考虑使用抗-MRSA 抗生素。这些因素的存在与否将为选择初始经验性抗生素提供有用的指导。
