Staphylococcus Aureus Pneumonia: Emergence of MRSA in the Community

Suzanne F. Bradley, MD

Disclosures

Semin Respir Crit Care Med. 2005;26(6):643-649. 

In This Article

The Prevalence of S. AUREUS Pneumonia: is it Changing?

In the past, staphylococcal pulmonary infection has been uncommon in healthy children and adults from developed countries.[13] It has been estimated that 1 to 10% of community-acquired pneumonia (CAP) and ≥ 10% of hospital-acquired pneumonia (HAP) are due to S. aureus.[14] In past reviews of serious S. aureus infection requiring hospitalization, invasive disease occurred in patients at the extremes of age with predisposing diseases; most of the infections were nosocomially acquired or health care related.[13,14,15,16]S. aureus accounted for 6% of pneumonias and 13% of empyemas at one medical center; ~40% of these cases were associated with bacteremia.[16] Respiratory infections (pneumonia with or without empyema or empyema alone) constituted the second or third cause of serious S. aureus infection, after skin and soft tissue infection (SSTI) and bone infection.[15,16]

Currently, there is little information about the actual incidence of CA-MRSA pneumonia nationwide. In a recent multicenter survey of population-based data and laboratory data from 2001 to 2002 in Atlanta, Baltimore, and Minnesota, 8 to 20% of MRSA infections occurred in patients without traditional risk factors, for an incidence of 18.0 to 25.7 per 100,000.[17] SSTIs account for the majority of CA-MRSA infections (75-77%); pneumonia occurred in only 2 to 6% of cases.[17,18] In a cohort of Minnesota hospitals, HA-MRSA pneumonia (22%) occurred more often than CA-MRSA cases, 22% versus 6%, respectively.[18] Thus one can anticipate that more cases of staphylococcal pneumonia, and CA-MRSA in particular, will be seen in addition to those populations that were traditionally at risk for S. aureus respiratory tract infection.

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