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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Methicillin resistance in Staphylococcus aureus (MRSA) and the coagulase-negative staphylococci (MRCNS) is widespread and continues to increase in prevalence, particularly in the health care setting. The clinical significance of methicillin resistance for patients with staphylococcal infections is not clear: studies in patients with bacteremia, pneumonia, and mediastinitis show a higher mortality with MRSA infection compared to methicillin-sensitive Staphylococcus aureus (MSSA) infection, though this may be due to underlying patient, pharmacodynamic, or microbiological differences. For serious methicillin-resistant staphylococcal infections, vancomycin-based regimens are preferred. Treatment alternatives for patients with severe methicillin-resistant infections who are unable to tolerate vancomycin include linezolid and quinupristin/dalfopristin; these agents should be considered second-line options, given the relative lack of clinical experience and the nonsignificant but consistent trends toward worse outcomes in bacteremia and pneumonia with these agents compared to vancomycin. For less severe infections, treatment options also include trimethoprim-sulfamethoxazole, or fluoroquinolones in combination with rifampin.
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PMID:Methicillin-resistant staphylococci and their treatment in the intensive care unit. 1608 23

Trauma is the leading cause of death in young people. Trauma deaths have a classic trimodal distribution; in late death (3 days to 3 weeks postinjury), infection is the principal cause. Because pneumonia is a major cause of morbidity in trauma patients, early identification of subjects at a high risk of developing nosocomial pneumonia (NP) can reduce morbidity and costs. Methicillin-sensitive Staphylococcus aureus (MSSA) is the predominant pathogen in multiple-trauma patients in coma, and nasal MSSA colonization at time of severe injury may increase the risk of MSSA pneumonia. In the remaining patients, gram-negative bacilli are responsible for the majority of cases. Prolonged mechanical ventilation, continuous enteral feeding, and craniotomy are risk factors for NP in trauma patients. Diagnosis of NP in these patients is difficult because radiographic infiltrates may not highlight any infection. In coma patients, coverage with a beta-lactam active against MSSA is mandatory. Variations in organisms and sensitivities across intensive care units due to differences in demographic characteristics or comorbidities should be considered.
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PMID:Pneumonia in head-injured and severe trauma patients. 1608 37

Since first described In 1961, methicillin-resistant Staphylococcus aureus (MRSA) has become a common nosocomial pathogen. Substantial increases in MRSA infections among nonhospitalized patients are being reported. Methicillin-resistant S. aureus is the most common isolate from skin and soft tissue infections in selected centers in the United States. Community-acquired MRSA strains differ from nosocomial strains in clinically relevant ways, such as in their propensity to cause skin and soft tissue infection and severe necrotizing pneumonia. Clinicians in numerous specialties, particularly primary care physicians, will likely evaluate patients presentIng with community-acquired MRSA and should become familiar with the epidemiology and clinical characteristics of and evolving therapeutic and preventive strategies for this infection.
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PMID:Epidemiology, treatment, and prevention of community-acquired methicillin-resistant Staphylococcus aureus infections. 1617 91

Methicillin-resistant Staphylococcus aureus (MRSA) was initially confined to hospitals, but in the late 1970s appeared in the community in the USA, primarily among intravenous drug users. In the 1990s, community MRSA (cMRSA) strains appeared in multiple areas of the world, and spread extensively. Initially, there were problems with the definition of 'community-acquired', which was exacerbated by the fact that if a time-based definition was used without stratification for risk factors, patients with healthcare-associated MRSA would be counted. Some cMRSA strains have entered the hospital environment to cause outbreaks of infection, which has added to the difficulty in separating the two types. cMRSA strains usually possess genes for Panton-Valentine leukocidin (PVL), which is associated with furunculosis and necrotizing pneumonia, and sometimes possess other virulence genes such as those for toxic shock syndrome or exfoliative toxins. Antimicrobial resistance to commonly used topical and oral agents is now appearing in certain cMRSA strains, which is complicating therapy. While cMRSA strains are usually susceptible to most non-beta-lactam antimicrobials, there is a lack of clinical trial data indicating which drugs have superior clinical efficacy. DNA fingerprinting methods have become more sophisticated over the last decade, and have determined that cMRSA strains have probably arisen from virulent methicillin-susceptible strains, most likely by horizontal transfer of methicillin-resistance genes from coagulase negative staphylococci to S. aureus on a limited number of occasions, and these clones have spread extensively throughout the world by person-to-person transmission. In Australia, the dominant cMRSA clones are the Western Australia, Oceania and Queensland strains.
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PMID:Epidemiology, clinical features and management of infections due to community methicillin-resistant Staphylococcus aureus (cMRSA). 1627 Oct 56

Methicillin-resistant Staphylococcus aureus (MRSA) is being recognized increasingly as a cause of community-acquired infection. The organism usually causes skin and soft tissue infection. Here, we present a patient with community-acquired MRSA pneumonia and review the literature. The patient, a 37-year-old Saudi male with no significant medical history was admitted with fever, respiratory distress and scrotal ulceration. Scrotal swabs and blood cultures grew MRSA. Imaging studies showed necrotizing pneumonia. Physical examination and echocardiographic findings revealed no evidence of endocarditis. The patient was treated successfully with 4 weeks of intravenous vancomycin. The infection appears to have originated in the skin and subcutaneous tissues of the scrotum, and subsequently led to necrotizing pneumonia. Community-acquired MRSA pneumonia has been associated with the production of Panton-Valentine leukocidin.
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PMID:Community-acquired MRSA bacteremic necrotizing pneumonia in a patient with scrotal ulceration. 1629 Dec 79

In the last few years, a dramatic increase of Methicillin-resistant Staphylococcus aureus (MRSA) detection in German hospitals can be recognized. Under this enormous pressure it is very important for infection control teams to assess the epidemiologic situation correctly. Therefore, a prospective multicenter hospital-based surveillance of MRSA cases was executed in four university hospitals with 1017-1333 beds in Germany. Routine surveillance data were recorded of all patients with MRSA isolates from clinical samples or screening cultures. Patients had been colonized or infected with MRSA during their hospital stay. In 2002 between 183 and 291 MRSA cases were treated in the respective hospitals (between 0.53 and 0.96 MRSA cases per 1000 patient days). Of these, 44.4% were MRSA infections. The most frequent type of MRSA infections were wound infections (56.9%) followed by pneumonia (21.0%) and bloodstream infections (15.1%). Of the infected patients 51.5% were already infected at admission. The median duration of isolation of MRSA patients in private rooms was between 11 and 16 days. Altogether 21,665 isolation days were observed in four hospitals; this means 1.52% of all patient days. On average, 9.0% of roommates were identified as MRSA carriers. Due to the high percentage of imported cases, the four university hospitals introduced a general screening for MRSA at admission in all ICUs and some further departments as well as an automatic alert system for readmitted patient with MRSA during their last hospital stay.
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PMID:The burden of MRSA in four German university hospitals. 1632 53

Gram-positive cocci, in particular Staphylococcus aureus, account for as much as one-third of all cases of hospital-acquired pneumonia, and treatment has become increasingly complex as the proportion of resistant isolates has increased. Methicillin-resistant S. aureus is of particular concern because this pathogen is now associated with hospital-acquired, ventilator-associated, community-acquired, and healthcare-associated pneumonia. Antibiotic therapy for ventilator-associated pneumonia is challenging because it can be caused by multiple pathogens, which can be resistant to multiple drugs. This article reviews the epidemiology of ventilator-associated pneumonia and describes options for antibiotic treatment. Particular attention is paid to pneumonia due to methicillin-resistant S. aureus. Studies suggest that vancomycin, the traditional treatment for ventilator-associated pneumonia, may not be the best option for this type of pneumonia and that other antibiotics, such as linezolid and clindamycin, might be better choices. New antibiotics with activity against methicillin-resistant S. aureus are under investigation and may soon become available for clinical use. Studies are needed to define the optimal choice of antibiotic for pneumonias caused by this organism, and these choices will need to be balanced with the need to minimize the emergence of resistance.
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PMID:Antibiotic management of ventilator-associated pneumonia due to antibiotic-resistant gram-positive bacterial infection. 1636 82

Methicillin-resistant Staphylococcus aureus (MRSA) should no longer be regarded as a strictly nosocomial pathogen. During the past decade, community-acquired MRSA (CA-MRSA) infections among young persons without healthcare-associated (HCA) risk factors have emerged in several areas worldwide. These infections are caused by strains that almost exclusively carry the staphylococcal cassette chromosome mec type IV element and the Panton-Valentine leukocidin genes and, unlike HCA-MRSA strains, are not multiresistant. Although the majority of CA-MRSA infections are mild skin and soft tissue infections, severe life-threatening cases of necrotizing pneumonia, necrotizing fasciitis, myonecrosis and sepsis have been reported. Clindamycin is an effective agent for skin and soft tissue infections, however attention should be paid to the possibility of the emergence of resistance during treatment in strains with the macrolide, lincosamide and group B streptogramin (MLS(B))-inducible resistance phenotype. For patients with invasive infections that may be caused be CA-MRSA, vancomycin, teicoplanin and linezolid represent appropriate empirical therapeutic options.
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PMID:Community-acquired methicillin-resistant Staphylococcus aureus infections. 1642 9

Methicillin resistance, long recognized as characteristic of nosocomial Staphylococcus aureus, has increasingly been identified in community-acquired strains in the past 15 years. The genotypes of community-associated methicillin-resistant S. aureus (MRSA) are different from nosocomial strains, and unlike nosocomial strains, they have a distinctive methicillin-resistance chromosomal cassette (designated type IV), are usually susceptible to multiple classes of antimicrobials other than beta-lactams, carry a distinctive virulence factor (the Panton-Valentine leukocidin), cause mainly skin and soft tissue infection and less frequently, necrotizing pneumonia, and involve predominantly children and young adults. Outbreaks have been reported in certain segments of the population (eg, football players, wrestlers, prison inmates, and native people) that often do not have the established risk factors for MRSA. However, these strains have also caused infections likely acquired in an institutional health care setting. Delay in starting appropriate antibiotic therapy for severe infections caused by MRSA can be life-threatening. This requires a reconsideration of the empiric choice of an anti-staphylococcal beta-lactam for seriously ill patients with suspected community-associated S. aureus infections.
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PMID:Community-associated methicillin-resistant Staphylococcus aureus: reconsideration of therapeutic options. 1644 97

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with significant mortality and morbidity. This retrospective study involved 76 episodes over four years in a district general hospital in the UK. Twenty-eight of these episodes (36.8%) occurred within 72 h of admission. All of these, however, had risk factors for MRSA acquisition and were classified as healthcare-associated bacteraemias. The mortality rates (all causes) at seven days and three months were 31.5% and 53.4%, respectively. Ten patients died before targeted therapy could be commenced. All patients in the study had multiple comorbidities, and pneumonia was a common diagnosis. Previous antibiotics, increased age, admission on surgical wards/intensive care units, and the presence of central venous cannulae and urinary catheters were risk factors for infection. In 48.7% of episodes, patients were not known to be colonized with MRSA prior to their bacteraemia. Empirical targeted therapy should be given to patients with risk factors for MRSA and staphylococci in blood cultures pending susceptibility results. Increased use of screening may also be required to reduce transmission and increase the likelihood of appropriate empirical antimicrobial therapy. Eradication of MRSA from carriers in the community should be considered to reduce the number of community-onset healthcare-associated bacteraemias.
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PMID:Community-onset healthcare-associated MRSA bacteraemia in a district general hospital. 1645 62


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