Bunnell Kristen L, Zullo Andrew R, Collins Christine, Adams Charles A
1 Department of Pharmacy, Rhode Island Hospital , Providence, Rhode Island.
2 Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, Rhode Island.
Surg Infect (Larchmt). 2017 Feb/Mar;18(2):196-201. doi: 10.1089/sur.2016.115. Epub 2016 Dec 22.
The timing and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in trauma patients are not well characterized. This information is critical for the selection of appropriate empiric antibiotics. The objective of this study was to determine the incidence of MRSA pneumonia in early-onset and late-onset pneumonia and to identify risk factors for MRSA in the trauma-burn intensive care unit (ICU).
We conducted a retrospective cohort study from January 2012 to March 2015 of patients in the trauma and burn ICU with clinical and microbiologic evidence of pneumonia. Demographics, injury type and severity, co-morbidities, antimicrobial agents, and MRSA nasal colonization at ICU admission were extracted from the medical record. A multi-variable exact logistic regression was performed to assess predictors of MRSA pneumonia.
Eighty patients with 88 episodes of pneumonia were included in the cohort. Ten patients had MRSA pneumonia, an overall incidence of 11.4% of pneumonia episodes with a median onset of seven days. The proportion of MRSA pneumonia episodes was not significantly different in early-onset (<5 days) or late-onset pneumonia, and there were no statistically significant risk factors for developing MRSA pneumonia. The majority of patients with MRSA had at least one known risk factor including homelessness, substance abuse, and receipt of broad-spectrum antibiotic agents.
The 11.4% overall incidence of MRSA pneumonia in this trauma-burn cohort was similar to what has been reported in other trauma populations, although MRSA was equally likely to be identified in early- and late-onset pneumonia. Our results suggest that risk factors other than duration of hospitalization may be important considerations in the decision to initiate MRSA-active empiric therapy for pneumonia in the trauma-burn ICU.
创伤患者耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的发生时间及危险因素尚未得到充分描述。这些信息对于选择合适的经验性抗生素至关重要。本研究的目的是确定早发性和晚发性肺炎中MRSA肺炎的发生率，并确定创伤 - 烧伤重症监护病房（ICU）中MRSA的危险因素。
我们对2012年1月至2015年3月期间在创伤和烧伤ICU中患有肺炎临床和微生物学证据的患者进行了一项回顾性队列研究。从病历中提取人口统计学、损伤类型和严重程度、合并症、抗菌药物以及ICU入院时的MRSA鼻腔定植情况。进行多变量精确逻辑回归以评估MRSA肺炎的预测因素。
该队列包括80例患者的88次肺炎发作。10例患者患有MRSA肺炎，肺炎发作的总体发生率为11.4%，中位发病时间为7天。早发性（<5天）或晚发性肺炎中MRSA肺炎发作的比例无显著差异，且发生MRSA肺炎无统计学上显著的危险因素。大多数患有MRSA的患者至少有一个已知危险因素，包括无家可归、药物滥用和接受广谱抗生素治疗。
该创伤 - 烧伤队列中MRSA肺炎的总体发生率为11.4%，与其他创伤人群的报告相似，尽管早发性和晚发性肺炎中MRSA的检出可能性相同。我们的结果表明，在决定对创伤 - 烧伤ICU中的肺炎启动针对MRSA的经验性治疗时，除住院时间外的危险因素可能是重要的考虑因素。
