Treatment of Staphylococcus aureus Pneumonia in Adults Hospitalized with Community-Acquired Pneumonia and MRSA Risk Factors
Adults admitted with community-acquired pneumonia who carry locally validated risk factors for MRSA require a modified empiric antibiotic strategy — one that goes beyond the standard CAP regimen.
The patient has community-acquired pneumonia and meets at least one locally validated MRSA risk criterion: prior respiratory isolation of MRSA, or recent hospitalization with receipt of parenteral antibiotics in the last 90 days. These are the most consistently strong individual risk factors for MRSA respiratory infection and justify empiric coverage beyond standard CAP therapy.
A standard CAP regimen is used together with added empiric MRSA-directed coverage. Blood and sputum cultures should be obtained at the outset; if cultures are negative for drug-resistant pathogens and the patient is improving, therapy can be deescalated at 48 hours. The specific agents and the complete treatment algorithm are in the full protocol.
Clinical goals: Clinical improvement and culture-negative results at 48 hours, resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, temperature), return of ability to eat, and normal mentation.
References
- We recommend clinicians only cover empirically for MRSA or P. aeruginosa in adults with CAP if locally validated risk factors for either pathogen are present (strong recommendation, moderate quality of evidence).
- The most consistently strong individual risk factors for respiratory infection with MRSA or P. aeruginosa are prior isolation of these organisms, especially from the respiratory tract, and/or recent hospitalization and exposure to parenteral antibiotics.
- Empiric treatment options for MRSA include vancomycin (15 mg/kg every 12 h, adjust based on levels) or linezolid (600 mg every 12 h).
- Finally, routine cultures in patients empirically treated for MRSA or P. aeruginosa allow deescalation to standard CAP therapy if cultures do not reveal a drug-resistant pathogen and the patient is clinically improving at 48 hours.
DOI: 10.1164/rccm.201908-1581ST
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