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. Shorr, et al. (2013) developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA.
The researchers identified patients admitted with pneumonia (Apr 2005 -- Mar 2009) at 62 hospitals in the U.S. They only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). They 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. The researchers validated the model in the remaining population.
The cohort included 5,975 patients and MRSA was identified in 14 percent. 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 percent while the prevalence of MRSA climbed to >30 percent when the score was 6 or greater. Their research was published in BMC Infectious Diseases.
Reference: Shorr AF, Myers DE, Huang DB, Nathanson BH, Emons MF and Kollef MH. A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia. BMC Infectious Diseases 2013, 13:268 doi:10.1186/1471-2334-13-268