K-526. Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Pneumonia in a Large Urban Teaching Hospital
Session: Poster Session: Gram-Positive VAP/HAP
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Methicillin-resistant Staphylococcus aureus (S. aureus [SA]) (MRSA) pneumonia is a major cause of hospital-acquired pneumonia in the US. The importance of MRSA in healthcare-associated pneumonia (HCAP) remains unclear, however. We address this issue in this study. Methods: We retrospectively identified all patients with SA HCAP admitted to a large US urban teaching hospital between January 2005 and December 2007, based on a discharge diagnosis of pneumonia and (all within 48h of admission): (1) positive SA culture (blood or sputum); (2) positive chest X-ray; (3) signs/symptoms of pneumonia; and (4) history of recent hospitalization, hemodialysis, chemotherapy, or other established criteria for HCAP. Patients were designated as having MRSA or methicillin-susceptible SA (MSSA) based on initial culture results. Results: A total of 128 patients with SA HCAP were identified. Mean (SD) age was 64 (17) years; 82 patients (64%) were nonwhite. Prevalence of diabetes, cancer, chronic renal failure, coronary artery disease, heart failure, peripheral vascular disease, and chronic respiratory disease was high (all >20%). Seventy-eight patients (61%) had positive MRSA cultures; USA-300 accounted for 15% of MRSA strains. Only 7 MRSA patients (9%) had vancomycin MIC values <1 mcg/ml by E-test. Patients with MRSA were more likely to have had a positive MRSA culture in the year prior to admission (19 [24%] vs 2 [4%] for MSSA patients; p=.003), and to have received antibiotics in the month prior to admission (20 [40%] vs 46 [59%] respectively; p=.046). Conclusion: More than one-half of patients with SA HCAP have MRSA; prior MRSA culture and recent (<30d) exposure to antibiotics are common findings in these patients.
Andy Shorr1, Carol Moore, PharmD2, Charu Taneja, MS, MPH3, Gerry Oster, Ph.D.3, James Spalding, PharmD4, Marc Zervos, MD5, Nadia Haque, Pharm, D6, Smita Kothari, PhD, MBA, RPh4, Sophia Zilber7 and  N. Haque,
Astellas Pharma US Inc. Role(s): Research Relationship, Received: Research Grant., (1)Washington Hospital Center, (2)Henry Ford Hospital, Detroit, MI, (3)Policy Analysis Inc. (PAI), Brookline, MA, (4)Astellas Pharma US, Inc., Deerfield, IL, (5)Henry Ford Health System, (6)Infectious Disease, Henry Ford Hospital, Detroit, MI, (7)Policy Analysis Inc.


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