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Predictive Factors of Methicillin-Resistant Staphylococcus aureus Infection in Elderly Patients with Community-Onset Pneumonia

View Article: PubMed Central - PubMed

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.

No MeSH data available.


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Receiver operating characteristic curves of the scoring system for prediction of methicillin-resistant Staphylococcus aureus infection in elderly patients with community-onset pneumonia.
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Figure 2: Receiver operating characteristic curves of the scoring system for prediction of methicillin-resistant Staphylococcus aureus infection in elderly patients with community-onset pneumonia.

Mentions: Based on the multivariate analysis, we created a scoring system to identify patients with MRSA infection. We assigned points as follows based on the logistic regression: 2 points for admission during influenza season; 3 points for chronic kidney disease; 3 points for ICU admission. Patients were divided into three groups by total scores. Figure 1 shows the association between total score using the scoring system and the prevalence of MRSA infection. As scores increased, the prevalence of MRSA pathogen in each group tended to increase (0.5% in the group with a score of 0, 2.2% in the group with a score 2–3, and 13.0% in the group with scores 5–8). Using ROC curves, the area under curve of the scoring system was 0.7900 (95% CI, 0.6801–0.8998; p<0.001) (Figure 2).


Predictive Factors of Methicillin-Resistant Staphylococcus aureus Infection in Elderly Patients with Community-Onset Pneumonia
Receiver operating characteristic curves of the scoring system for prediction of methicillin-resistant Staphylococcus aureus infection in elderly patients with community-onset pneumonia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392492&req=5

Figure 2: Receiver operating characteristic curves of the scoring system for prediction of methicillin-resistant Staphylococcus aureus infection in elderly patients with community-onset pneumonia.
Mentions: Based on the multivariate analysis, we created a scoring system to identify patients with MRSA infection. We assigned points as follows based on the logistic regression: 2 points for admission during influenza season; 3 points for chronic kidney disease; 3 points for ICU admission. Patients were divided into three groups by total scores. Figure 1 shows the association between total score using the scoring system and the prevalence of MRSA infection. As scores increased, the prevalence of MRSA pathogen in each group tended to increase (0.5% in the group with a score of 0, 2.2% in the group with a score 2–3, and 13.0% in the group with scores 5–8). Using ROC curves, the area under curve of the scoring system was 0.7900 (95% CI, 0.6801–0.8998; p<0.001) (Figure 2).

View Article: PubMed Central - PubMed

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 &ge;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&ndash;8.202; p=0.045), chronic kidney disease (OR, 3.555; 95% CI, 1.157&ndash;10.926; p=0.027), and intensive care unit admission (OR, 3.385; 95% CI, 1.035&ndash;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&ndash;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&ndash;0.899; p&lt;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.

No MeSH data available.


Related in: MedlinePlus