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Open Access Highly Accessed Research article

A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia

Andrew F Shorr1*, Daniela E Myers2, David B Huang3, Brian H Nathanson4, Matthew F Emons5 and Marin H Kollef6

Author Affiliations

1 Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington DC, USA

2 Pfizer Inc, Outcomes Research, Collegeville, USA

3 Formerly of Pfizer Inc, US Medical Affairs, Collegeville, USA

4 OptiStatim, LLC, Longmeadow, USA

5 Cerner Corporation, Research Division, Culver City, USA

6 Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, USA

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BMC Infectious Diseases 2013, 13:268  doi:10.1186/1471-2334-13-268

Published: 6 June 2013

Abstract

Background

Methicillin-resistant Staphylococcus aureus (MRSA) represents an important pathogen in healthcare-associated pneumonia (HCAP). The concept of HCAP, though, may not perform well as a screening test for MRSA and can lead to overuse of antibiotics. We developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA.

Methods

We identified patients admitted with pneumonia (Apr 2005 – Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the presence of MRSA based on logistic regression (two-thirds of cohort) and developed a risk prediction model based on these factors. We validated the model in the remaining population.

Results

The cohort included 5975 patients and MRSA was identified in 14%. The final risk score consisted of eight variables and a potential total score of 10. Points were assigned as follows: two for recent hospitalization or ICU admission; one each for age < 30 or > 79 years, prior IV antibiotic exposure, dementia, cerebrovascular disease, female with diabetes, or recent exposure to a nursing home/long term acute care facility/skilled nursing facility. This study shows how the prevalence of MRSA rose with increasing score after stratifying the scores into Low (0 to 1 points), Medium (2 to 5 points) and High (6 or more points) risk. When the score was 0 or 1, the prevalence of MRSA was < 10% while the prevalence of MRSA climbed to > 30% when the score was 6 or greater.

Conclusions

MRSA represents a cause of pneumonia presenting to the hospital. This simple risk score identifies patients at low risk for MRSA and in whom anti-MRSA therapy might be withheld.