Predictive Factors of Methicillin-Resistant Staphylococcus aureus Infection in Elderly Patients with Community-Onset Pneumonia.
10.4046/trd.2017.80.2.201
- Author:
Hyeyoung JWA
1
;
Jong Wook BEOM
;
Jong Hoo LEE
Author Information
1. Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea. lovlet@paran.com
- Publication Type:Original Article
- Keywords:
Methicillin-Resistant Staphylococcus aureus;
Pneumonia;
Community-Acquired Infections;
Mortality
- MeSH:
Aged*;
Anti-Bacterial Agents;
Community-Acquired Infections;
Hospitalization;
Humans;
Influenza, Human;
Intensive Care Units;
Logistic Models;
Mass Screening;
Methicillin Resistance*;
Methicillin-Resistant Staphylococcus aureus*;
Mortality;
Multivariate Analysis;
Pneumonia*;
Renal Insufficiency, Chronic;
Retrospective Studies;
Risk Factors;
Seasons;
Sensitivity and Specificity
- From:Tuberculosis and Respiratory Diseases
2017;80(2):201-209
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is a severe and life-threatening disease in patients with community-onset (CO) pneumonia. However, the current guidelines lack specificity for a screening test for MRSA infection. METHODS: This study was retrospectively conducted in elderly patients aged ≥65 years, who had contracted CO-pneumonia during hospitalization at the Jeju National University Hospital, between January 2012 and December 2014. We analyzed the risk factors of MRSA in these patients and developed a scoring system to predict MRSA infection. RESULTS: A total of 762 patients were enrolled in this study, including 19 (2.4%) with MRSA infection. Healthcare-associated pneumonia (HCAP) showed more frequent MRSA infection compared to community-acquired pneumonia (4.4% vs. 1.5%, respectively; p=0.016). In a multivariate logistic regression analysis, admissions during the influenza season (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.022–8.202; p=0.045), chronic kidney disease (OR, 3.555; 95% CI, 1.157–10.926; p=0.027), and intensive care unit admission (OR, 3.385; 95% CI, 1.035–11.075; p=0.044) were identified as predictive factors for MRSA infection. However, the presence of HCAP was not significantly associated with MRSA infection (OR, 1.991; 95% CI, 0.720–5.505; p=0.185). The scoring system consisted of three variables based on the multivariate analysis, and showed moderately accurate diagnostic prediction (area under curve, 0.790; 95% CI, 0.680–0.899; p<0.001). CONCLUSION: MRSA infection would be considered in elderly CO-pneumonia patients, with three risk factors identified herein. When managing elderly patients with pneumonia, clinicians might keep in mind that these risk factors are associated with MRSA infection, which may help in selecting appropriate antibiotics.
