When and How Should We Cover Patients for Community-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia?

Iris      D. Boyeras; Carlos      M. Luna

Abstract

Purpose of Review: Staphylococcus aureus and particularly MRSA has become an increasingly important etiology of pneumonia at the community settings. Associated with highest morbidity, mortality and costs in public health, it represents a major challenge for the management of this group of patients. Recent Findings: MRSA estimated incidence for community acquired pneumonia has risen in the past decades, and its characterized for been particularly virulent and difficult to treat. There are some clinical and radiological features that suggest CA-MRSA pneumonia, like young age, previous flulike illness, acute impaired general status, and bilateral consolidation with tendency to cavitations. Although vancomycin at standard doses remains as the mainstay for its treatment, the increasing rate of treatment failure have prompted other strategies of use (more frequent administration, continuous infusion, combination therapy), and the use of newer antimicrobials, particularly linezolid, with pharmacokinetic and pharmacodinamics profiles that produced promisingly improving clinical results. Summary: Clinicians should be aware of CA-MRSA as a potential pathogen in any patient presenting with severe community-acquired pneumonia; if a risk assessment suggests the possibility of MRSA, initial empiric therapy directed against MRSA appears reasonable until this infection can be excluded microbiologically.

Keywords: Methicillin-resistant Staphylococcus aureus, CA-MRSA, community acquired pneumonia, CAP, gene regulation, EPIDEMIOLOGY, RADIOLOGIC PATTERN, Gram's stain, Empirical Treatment, pharmacokinetics, pharmacodynamics, epithelial lining fluid (