Expanded Clinical Presentation of Community-Acquired Methicillin-Resistant Staphylococcus aureus Pneumonia
Expanded Clinical Presentation of Community-Acquired Methicillin-Resistant Staphylococcus aureus Pneumonia
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DOI：
10.1378/chest.09-1562
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发表时间：
2010-07-10
期刊：
影响因子：
9.6
通讯作者：
Wunderink, Richard G.
中科院分区：
文献类型：
--
作者：
Lobo, L. Jason;Reed, Kurt D.;Wunderink, Richard G.
背景资料：社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）已被证明可引起社区获得性肺炎（CAP），以坏死性特征显著。CA-MRSA CAP. Methods的发生频率，危险因素和最佳治疗尚不清楚：这是一个回顾性分析的病人承认西北纪念医院从2005年1月至2007年4月的肺炎和呼吸道或血培养阳性CA-MRSA的初步临床表现。CA-MRSA的定义是基于对甲氧苄啶/磺胺甲恶唑和克林霉素的敏感性。结果：15例CA-MRSA CAP患者在28个月期间被确定。在接受检测的14名患者中，只有一名患者有先前流感的证据，并且没有发现季节性模式。7名患者从未入住ICU。14例胸部CT扫描中有8例有肺坏死的证据。15例中有9例在住院早期有胸腔积液的证据，9例中有5例需要至少一次胸腔引流术。15名患者中有7名免疫功能低下（3名HIV，1名急性淋巴细胞白血病[ALL]，1名高剂量类固醇和2名免疫球蛋白缺乏症），另有3名患者患有糖尿病。死亡率仅为13%（2/15）; 2例死亡均发生在严重免疫功能低下的患者（化疗后ALL和AIDS）。15例患者中有14例接受了抑制外毒素产生（克林霉素或利奈唑胺）的抗菌药物治疗。结论：CA-MRSA肺炎不一定是流感后感染。尽管在许多情况下有坏死特征，但在我们的系列研究中，CA-MRSA肺炎的死亡率低于先前报道的死亡率，并且患者通常不需要ICU护理。用抑制外毒素产生和/或非致病性菌株的抗生素治疗可以解释这种改善的结果。胸部2010; 138（1）：130-136
Background: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been documented to cause community-acquired pneumonias (CAP), notable for necrotizing features. The frequency of occurrence, risk factors, and optimal treatment of CA-MRSA CAP are unclear.Methods: This was a retrospective analysis of patients admitted to Northwestern Memorial Hospital from January 2005 to April 2007 with initial clinical presentation of pneumonia and respiratory or blood culture positive for CA-MRSA. Definition of CA-MRSA was based on sensitivity to trimethoprim/sulfamethoxazole and clindamycin.Results: Fifteen patients with CA-MRSA CAP were identified during the 28-month period. Only one of the 14 patients tested had evidence of preceding influenza, and no seasonal pattern was seen. Seven patients were never admitted to the ICU. Eight of 14 with chest CT scans had evidence of lung necrosis. Nine of 15 had evidence of pleural effusions early in their hospital course, and five of nine required at least one pleural drainage procedure. Seven of 15 were immunocompromised (three HIV, one acute lymphocytic leukemia [ALL], one high-dose steroids, and two immunoglobulin deficiency) with an additional three patients with diabetes. Mortality was only 13% (two of 15); both deaths occurred in patients with severe immunocompromise (ALL post chemotherapy and AIDS). Fourteen of 15 patients were treated with antimicrobials that inhibit exotoxin production (clindamycin or linezolid).Conclusions: CA-MRSA pneumonia is not necessarily a post-influenza infection. Despite necrotizing features in many, the mortality of CA-MRSA pneumonia in our series is lower than previously reported, and patients do not routinely require ICU care. Treatment with antibiotics that inhibit exotoxin production and/or nontoxigenic strains may explain this improved outcome. CHEST 2010; 138(1):130-136