Application of a methicillin-resistant Staphylococcus aureus risk score for community-onset pneumonia patients and outcomes with initial treatment

BMC Infectious Diseases

Research Article

Chen-pin Wang¹  Russell T. Attridge²  Kelly R. Reveles³  Christopher R. Frei³  Jim Koeller³  Grace C. Lee³  Besu F. Teshome⁴  Eric M. Mortensen⁵ 

[1] Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX, USA;Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, USA;South Texas Veterans Health Care System, San Antonio, TX, USA;Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA;Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MSC-6220, 78229, San Antonio, TX, USA;St. Louis College of Pharmacy, St. Louis, MO, USA;Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA;Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MSC-6220, 78229, San Antonio, TX, USA;The VA North Texas Health Care System, Dallas, TX, USA;The University of Texas Southwestern Medical Center, Dallas, TX, USA;

关键词: Chronic Obstructive Pulmonary Disease;    Intensive Care Unit Admission;    Veteran Health Administration;    Veteran Health Administration Hospital;    HCAP Patient;   

DOI  :  10.1186/s12879-015-1119-1

 received in 2014-11-01, accepted in 2015-09-10,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundCommunity-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an evolving problem, and there is a great need for a reliable method to assess MRSA risk at hospital admission. A new MRSA prediction score classifies CO-pneumonia patients into low, medium, and high-risk groups based on objective criteria available at baseline. Our objective was to assess the effect of initial MRSA therapy on mortality in these three risk groups.MethodsWe conducted a retrospective cohort study using data from the Veterans Health Administration (VHA). Patients were included if they were hospitalized with pneumonia and received antibiotics within the first 48 h of admission. They were stratified into MRSA therapy and no MRSA therapy treatment arms based on antibiotics received in the first 48 h. Multivariable logistic regression was used to adjust for potential confounders.ResultsA total of 80,330 patients met inclusion criteria, of which 36 % received MRSA therapy and 64 % did not receive MRSA therapy. The majority of patients were classified as either low (51 %) or medium (47 %) risk, with only 2 % classified as high-risk. Multivariable logistic regression analysis demonstrated that initial MRSA therapy was associated with a lower 30-day mortality in the high-risk group (adjusted odds ratio 0.57; 95 % confidence interval 0.42–0.77). Initial MRSA therapy was not beneficial in the low or medium-risk groups.ConclusionsThis study demonstrated improved survival with initial MRSA therapy in high-risk CO-pneumonia patients. The MRSA risk score might help spare MRSA therapy for only those patients who are likely to benefit.

【 授权许可】

CC BY   
© Teshome et al. 2015