고령의 비병원성 폐렴 환자에서 메티실린 내성 황색 포도상 구균 감염의 임상적 특징과 이를 예측하는 인자

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection has been reported severe and life-threatening disease in patients with non-nosocomial pneumonia, but data are limited. Also, optimal prediction for MRSA infection in these patients has been not fully established. We aimed to evaluate the clinical characteristics and the risk factors of MRSA infection in elderly patients hospitalized with non-nosocomial pneumonia. Methods: This study was retrospectively conducted in elderly patients with community acquired or healthcare-associated pneumonia that were hospitalized in Jeju national university hospital between January 2012 and December 2013. Results: A total of 362 patients were enrolled and 16(4.4%) had MRSA infection. The MRSA group showed worse clinical parameters at onset, and PSI score were higher than in the non-MRSA group (144 vs. 117, p = 0.007). Total in-hospital mortality was higher in the MRSA group, although without statistical significance (31.2% vs. 13.8%; p = 0.068). Clinical outcomes including duration of antibiotic therapy (14 vs. 10 days; p = 0.017), the rates of antibiotics changes (75.0% vs. 23.6%; p < 0.001), use of inappropriate antibiotics (100% vs. 5.2%; p < 0.001), failure of initial antibiotics therapy (81.2% vs. 24.8%; p < 0.001), and length of hospital stay (14 vs. 9 days; p = 0.021) were significantly worse in the MRSA group. In a multivariate logistic regression analysis, a high PSI score was identified as a predictive factor for MRSA infection (Odds ratio = 1.014, p = 0.037). By contrast, the presence of healthcare-associated pneumonia or nursing home-acquired pneumonia, and CRP level were not risk factors for MRSA infection. Conclusions: MRSA infection in elderly patients admitted with non-nosocomial pneumonia was associated with overall worsened clinical outcomes. And we suggested that the risk of MRSA infection might be related to a high PSI score.