HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (16) Citing Articles via Google Scholar Google Scholar Articles by DeRyke, C. A. Articles by McKinnon, P. S. Search for Related Content PubMed PubMed Citation Articles by DeRyke, C. A. Articles by McKinnon, P. S.

Epidemiology, Treatment, and Outcomes of Nosocomial Bacteremic Staphylococcus aureus Pneumonia^*

^* From the Anti-Infective Research Laboratory, Wayne State University, Detroit, MI (Drs. Rybak and McKinnon); the Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MO (Dr. McKinnon); the Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT (Dr. DeRyke); and Albany College of Pharmacy, Albany, NY (Dr. Lodise).

Correspondence to: Peggy S. McKinnon, PharmD, Barnes-Jewish Hospital, Mailstop 90–52-411, 216 South Kings Hwy, St. Louis, MO 63110; e-mail: psm9154{at}bjc.org

Objective: To describe outcomes associated with nosocomial bacteremic Staphylococcus aureus pneumonia (NBSAP) and to determine whether delay in adequate antimicrobial treatment is a risk factor for negative clinical and microbiological outcomes.

Design: Retrospective cohort analysis.

Setting: This study was conducted at Detroit Receiving Hospital and University Health Center, which is a 279-bed, level 1 trauma center in Detroit, MI.

Patients: All episodes of NBSAP identified from January 1, 1999, to April 30, 2004.

Results: Of 206 patients identified over a 5-year period with positive blood and respiratory cultures for S aureus, 60 patients met strict clinical, radiographic, and microbiological criteria for NBSAP. The overall mean (± SD) characteristics include the following: age, 55.5 ± 15.0 years; acute physiology and chronic health evaluation II score, 20 (range, 3 to 41); ICU at onset, 93.3%; mechanical ventilation, 83.3%; length of stay (LOS) prior to NBSAP, 9 days (range, 2 to 81 days); methicillin-resistant S aureus (MRSA) rate, 70%; and all-cause hospital and infection-related mortality (IRM), 55.5% and 40.0%, respectively. Overall, S aureus pneumonia developed late in the patient’s hospital stay in ICU patients previously receiving mechanical ventilation and was associated with high crude mortality and IRM rates. No significant difference existed with respect to mortality or infection-related LOS between patients who had received early appropriate antibiotic therapy vs those who had received delayed appropriate antibiotic therapy at the onset of pneumonia or in patients with methicillin-sensitive S aureus pneumonia vs those with MRSA pneumonia.

Conclusion: IRM from NBSAP is high, and standard therapies evaluated at the time of this study resulted in poor clinical outcomes. Delayed therapy was not found to be a predictor of adverse outcomes; however, this lack of ability to detect a difference may be a product of small sample size. These findings suggest that newer agents with enhanced clinical activity in NBSAP are needed and that these should be evaluated in a real-world setting, where outcomes of the most ill patients can be assessed.

Key Words: bacteremia • clinical outcomes • critical care • cross-infection • hospital mortality • ICU • infection • staphylococcal infections • staphylococcal pneumonia • ventilator-associated pneumonia

This article has been cited by other articles:

				M. N. Jeffres, W. Isakow, J. A. Doherty, P. S. McKinnon, D. J. Ritchie, S. T. Micek, and M. H. Kollef Predictors of Mortality for Methicillin-Resistant Staphylococcus aureus Health-Care-Associated Pneumonia: Specific Evaluation of Vancomycin Pharmacokinetic Indices. Chest, October 1, 2006; 130(4): 947 - 955. [Abstract] [Full Text] [PDF]

				M. H. Kollef and S. T. Micek Staphylococcus Aureus Pneumonia: A "Superbug" Infection in Community and Hospital Settings Chest, September 1, 2005; 128(3): 1093 - 1097. [Full Text] [PDF]