Figure - available via license: Creative Commons Attribution 2.0 Generic
Content may be subject to copyright.
Prevalence of methicillin-resistant Staphylococcus aureus among patients presenting with pneumonia to the hospital as a function of the total risk score.
Source publication
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 unli...
Citations
... Furthermore, pneumonia caused by S. aureus has been shown to have a 30-day mortality rate more than 4 times higher (41% versus 9.5%, p=0.001) and a hospitalization time more than 2 times higher (24.2% versus 12.8%, p=0.001) compared to the classic pathogen causing pneumonia, Streptococcus pneumoniae [6]. Regarding prognosis, old age is a risk factor for increasing the incidence of MRSA [12], and is also a factor associated with a high mortality rate due to pneumonia [3]. In Vietnam, there have been some studies on pneumonia caused by S. aureus, but no studies have been conducted on the elderly population. ...
... It is evident from our results that both primary and secondary outcomes occur relatively frequently, which is consistent with the severe clinical course of pneumonia caused by S. aureus compared to classical pneumococcal pathogens as demonstrated in various parameters such as PSI, pleural effusion, altered mental status, BUN, leukocytosis, and impaired oxygen exchange as seen in the study by Thabet et al [15]. Additionally, advanced age has long been established as a risk factor for mortality in pneumonia in general [3] and increases the likelihood of MRSA infection [12], thus contributing to a higher risk of complications and adverse outcomes, specifically in S. aureus pneumonia [4]. ...
Objectives: Community-acquired pneumonia is a notable contributor to mortality from infectious diseases on a worldwide scale, especially in the older population. Staphylococcus aureus is a prevalent infection known to cause severe pneumonia, often leading to a high incidence of complications and fatality. The study's objective was to assess the treatment outcomes and some factors associated with mortality rates of Staphylococcus aureus pneumonia in older people. Subjects and method: A cross-sectional study was conducted with 93 patients diagnosed with Staphylococcus aureus pneumonia admitted to Can Tho Central General Hospital from April 2021 to May 2023. Results: The research results showed clinical outcomes including 30-day all-cause death rates and pneumonia-related complications were slightly higher in the age group over 60 compared to those aged 60 and under, but the difference was not statistically significant. After performing multivariate analysis, it was found that heart failure (OR = 5.68, 95% CI: 1.01-32.1, p = 0.049) and central nervous system disease (OR = 5.26, 95% CI: 1.32-20.9, p = 0.018) were found to be independent factors that increased the mortality rate in individuals aged over 60. Conclusion: Clinical practitioners should evaluate and manage comorbidities regarding heart failure and central nervous system diseases during treatment of Staphylococcus aureus pneumonia due to its elevated fatality rate, especially in old patients.
... The risk of MRS infection in pneumonia needs to be addressed when designing empirical therapy regimens. According to previous studies, risk factors for MRS infection included tobacco use, chronic obstructive pulmonary disease, recent antibiotic exposure, illicit drug use, and chest tubes [2,7]. MRSA pneumonia was also associated with male gender, age over 74, diabetes, a recent nursing home or hospital stay, recent exposure to fluoroquinolones or antibiotics for Gram-positive organisms, and severe pneumonia [8]. ...
... In this study, prior intravenous antibiotic use within 90 days, severity of pneumonia, respiratory failure, tracheostomy or endotracheal tube, urinary catheterization, central venous catheterization, nasogastric intubation, skin infection, and pneumatoceles were associated with MRS pneumonia at a p-value of below 0.1. These risk factors for MRS infection are in line with the current literature [7,8]. According to the American Thoracic Society (ATS), hospitalization history, especially frequent hospital admissions and prolonged hospital stays, is independently associated with MRSA infection [19]. ...
... The score consisted of eight variables and a possible total score of 10. The MRSA infection probability was lower by 10% at a score of 0 to 1 and could be above 30% when the score was 6 or greater [7]. Another retrospective study showed that a history of MRSA infection (OR 5.6, 95% CI 1.56-20.63) ...
The aim of this study was to create a dynamic web-based tool to predict the risks of methicillin-resistant Staphylococcus spp. (MRS) infection in patients with pneumonia. We conducted an observational study of patients with pneumonia at Cho Ray Hospital from March 2021 to March 2023. The Bayesian model averaging method and stepwise selection were applied to identify different sets of independent predictors. The final model was internally validated using the bootstrap method. We used receiver operator characteristic (ROC) curve, calibration, and decision curve analyses to assess the nomogram model’s predictive performance. Based on the American Thoracic Society, British Thoracic Society recommendations, and our data, we developed a model with significant risk factors, including tracheostomies or endotracheal tubes, skin infections, pleural effusions, and pneumatoceles, and used 0.3 as the optimal cut-off point. ROC curve analysis indicated an area under the curve of 0.7 (0.63–0.77) in the dataset and 0.71 (0.64–0.78) in 1000 bootstrap samples, with sensitivities of 92.39% and 91.11%, respectively. Calibration analysis demonstrated good agreement between the observed and predicted probability curves. When the threshold is above 0.3, we recommend empiric antibiotic therapy for MRS. The web-based dynamic interface also makes our model easier to use.
... Physicians should adopt simple risk scores to select the most appropriate antibiotic regimens. This individualized approach may help clinicians to identify those patients who need an empirical broad-spectrum antibiotic therapy [4,16]. ...
Community-acquired pneumonia (CAP) is a leading cause
of mortality and morbidity worldwide. In this scenario,
the spread of multidrug-resistant (MDR) pathogens such as
P. aeruginosa, methicillin-resistant S. aureus (MRSA) and
Enterobacterales is of major concern due to challenges in
antimicrobial therapy.
In 2019 the American Thoracic Society (ATS) and the
Infectious Disease Society of America (IDSA) updated the
guidelines for diagnosis and treatment of CAP based on a
series of new questions, confirming many recommendations
but also changing some important aspects compared to previous
guidelines. For instance, for the management of
inpatients with non-severe CAP and without risk factors for
MRSA or P. aeruginosa, the guidelines recommended an
empiric treatment regimen based on the combination therapy
of a beta-lactam, mainly ceftriaxone 1–2 g daily, with
a macrolide or, if contraindicated, with fluoroquinolones or
doxycycline.
... Specifically, we compare with the following four heuristic policies: isolate all emergency patients, isolate all patients with surgery history within 90 days, isolate all patients with invasive device use history within 90 days, and isolate all patients with dialysis history within 90 days. The four features used in these policies are all considered to be highly risky 56,60,61 . As shown in Fig. 6 for UVA-Precovid, Greedy-Spectral can also suppress MRSA outbreak better than these clinical heuristic precaution policies. ...
Healthcare-associated infections (HAIs) are a major problem in hospital infection control. Although HAIs can be suppressed using contact precautions, such precautions are expensive, and we can only apply them to a small fraction of patients (i.e., a limited budget). In this work, we focus on two clinical problems arising from the limited budget: (a) choosing the best patients to be placed under precaution given a limited budget to minimize the spread (the isolation problem), and (b) choosing the best patients to release when limited budget requires some of the patients to be cleared from precaution (the clearance problem). A critical challenge in addressing them is that HAIs have multiple transmission pathways such that locations can also accumulate ‘load’ and spread the disease. One of the most common practices when placing patients under contact precautions is the regular clearance of pathogen loads. However, standard propagation models like independent cascade (IC)/susceptible-infectious-susceptible (SIS) cannot capture such mechanisms directly. Hence to account for this challenge, using non-linear system theory, we develop a novel spectral characterization of a recently proposed pathogen load based model, 2-Mode-SIS model, on people/location networks to capture spread dynamics of HAIs. We formulate the two clinical problems using this spectral characterization and develop effective and efficient algorithms for them. Our experiments show that our methods outperform several natural structural and clinical approaches on real-world hospital testbeds and pick meaningful solutions.
... Trong đó, đái tháo đường ảnh hưởng lên hoạt động của hệ miễn dịch, bệnh mạch máu não làm suy yếu các cơ chế miễn dịch tại chỗ như phản xạ ho khạc, phản xạ đóng nắp thanh môn làm tăng nguy cơ hít phải vi khuẩn thường trú từ đường hô hấp trên kể cả S. aureus. Đái tháo đường ở đối tượng nữ giới và bệnh mạch não cũng là 2 tiêu chí xuất hiện trong thang điểm lượng giá nguy cơ viêm phổi do MRSA theo Shorr A. F. và cộng sự [11]. ...
Đặt vấn đề: Viêm phổi do Staphylococcus aureus do nhiễm khuẩn có nguồn gốc cộng đồng hay bệnh viện đều có khả năng gây bệnh cảnh lâm sàng nặng và tỷ lệ tử vong cao mặc dù đã có nhiều tiến bộ trong chẩn đoán và điều trị. Mục tiêu nghiên cứu: Khảo sát đặc điểm lâm sàng, cận lâm sàng và kết quả điều trị ở bệnh nhân viêm phổi do Staphylococcus aureus. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang có phân tích được tiến hành trên 65 bệnh nhân viêm phổi do Staphylocccus aureus. Kết quả: lâm sàng nổi bật với sốt cao (75%), suy hô hấp (70,8%), tổn thương nhiều hơn 1 thùy (75,4%) trên X quang ngực thẳng. Đặc điểm kháng sinh đồ cho thấy tỷ lệ cao S. aureus kháng 82,8% với oxacillin, clindamycin 86,2%, levofloxacin 60,9%, ciprofloxacin 60,7% và gentamycin 72,7%. Kháng sinh còn nhạy cảm gồm có vancomycin (100%) và linezolide (98,5%). Tỷ lệ người bệnh khỏi bệnh và thất bại điều trị lần lượt là 52,3% và 47,7%. Kết luận: Viêm phổi do Staphylococus aureus có bệnh cảnh lâm sàng nặng, tổn thương phổi rộng và tỷ lệ thất bại điều trị cao, hai kháng sinh còn nhạy cảm là vancomycine và linezolide.
... In Intensive Care, it is frequent for patients to share devices such as ventilators, which leads to a more severe risk of infection when the number of in-room contacts increases. Besides, most patients in Gerontology rooms are older adults with comorbidities associated with MRSA susceptibility (i.e., age >79, prior nursing home residence, antibiotic exposure, dementia, stroke, or diabetes), which brings a higher risk for acquiring MRSA from the environment with more physical contact [41]. ...
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria resistant to certain antibiotics, making it difficult to prevent MRSA infections. Among decades of efforts to conquer infectious diseases caused by MRSA, many studies have been proposed to estimate the causal effects of close contact (treatment) on MRSA infection (outcome) from observational data. In this problem, the treatment assignment mechanism plays a key role as it determines the patterns of missing counterfactuals -- the fundamental challenge of causal effect estimation. Most existing observational studies for causal effect learning assume that the treatment is assigned individually for each unit. However, on many occasions, the treatments are pairwisely assigned for units that are connected in graphs, i.e., the treatments of different units are entangled. Neglecting the entangled treatments can impede the causal effect estimation. In this paper, we study the problem of causal effect estimation with treatment entangled in a graph. Despite a few explorations for entangled treatments, this problem still remains challenging due to the following challenges: (1) the entanglement brings difficulties in modeling and leveraging the unknown treatment assignment mechanism; (2) there may exist hidden confounders which lead to confounding biases in causal effect estimation; (3) the observational data is often time-varying. To tackle these challenges, we propose a novel method NEAT, which explicitly leverages the graph structure to model the treatment assignment mechanism, and mitigates confounding biases based on the treatment assignment modeling. We also extend our method into a dynamic setting to handle time-varying observational data. Experiments on both synthetic datasets and a real-world MRSA dataset validate the effectiveness of the proposed method, and provide insights for future applications.
... Following the recommendation to avoid using the term HCAP, 6 several prediction scores have been proposed for predicting drug-resistant pathogens in CAP, including the DRIP, Shorr, and PES scores. [29][30][31] While the parameters included in the scores differ, they share some well-established risk factors, such as colonization of drug-resistant pathogens, history of hospitalization, and antibiotic use. However, the specific drug-resistant organisms focused on by these scores were different. ...
... However, the specific drug-resistant organisms focused on by these scores were different. For example, the DRIP and Shorr scores focused on MRSA and P. aeruginosa, 29,30 while the PES score also included ESBL producing EB. 31 After validation, the sensitivity and specificity of each score may vary depending on the local epidemiology. 29,32,33 Since the CREPE score is designed to predict 3GCR EB-CAP, it may be suitable for areas with a high prevalence of EB-CAP, such as in Asia. 10 This study has some limitations. ...
... Moreover, parameters in the score are consistent with common factors from other scores, and controversial risk factors from other scores were excluded. [29][30][31] Finally, resulting from inclusion of all EB-CAP patients, there are no available data for score validation. Further studies, particularly utilizing randomized control designs, should be conducted to validate the score and evaluate its impact on reducing the overuse of unnecessary broad-spectrum antibiotics. ...
Purpose
To evaluate risk factors and develop a prediction score for community-acquired pneumonia caused by third-generation cephalosporin-resistant Enterobacterales (3GCR EB-CAP).
Patients and Methods
A retrospective study was conducted by reviewing the medical records of patients hospitalized with community-acquired pneumonia caused by Enterobacterales (EB-CAP) between January 2015 and August 2021 at Srinagarind Hospital, Khon Kaen University, Thailand. Logistic regression was used to analyze clinical parameters associated with 3GCR EB-CAP. The coefficients of significant parameters were simplified to the nearest whole number for a prediction score, called the CREPE (third-generation Cephalosporin Resistant Enterobacterales community-acquired Pneumonia Evaluation).
Results
A total of 245 patients with microbiologically confirmed EB-CAP (100 in the 3GCR EB group) were analyzed. Independent risk factors for 3GCR EB-CAP included in the CREPE score were (1) recent hospitalization within the past month (1 point), (2) multidrug-resistant EB colonization (1 point), and (3) recent intravenous antibiotic use (2 points for within the past month or 1.5 points for between one and twelve months). The CREPE score had an area under the receiver operating characteristic curve (ROC) of 0.88 (95% CI 0.84–0.93). Using a cut-off point of 1.75, the score had a sensitivity and specificity of 73.5% and 84.6%, respectively.
Conclusion
In areas with high prevalence of EB-CAP, the CREPE score can assist clinicians in selecting appropriate empirical therapy and reducing overuse of broad-spectrum antibiotics.
... 4,5 Commonly, the tested population is limited to specific populations, such as patients with ventilator-associated pneumonia. 6 Due to the complex association of each risk factor, it is often difficult to discern actual risks when multiple risk factors simultaneously exist. For example, previous exposure to cephalosporine and fluoroquinolone were considered risk factors. ...
Methicillin-resistant Staphylococcus aureus (MRSA) is a common bacterial cause of morbidity and mortality. Our deep-learning model (PyTorch_EHR) processes time-series structured electronic health record (EHR) data, including previous cultures and antimicrobial exposures, to predict the lab result of MRSA culture positivity over the next two weeks. After training and evaluation on data from 8,164 MRSA and 22,563 non-MRSA patient events from Memorial Hermann Hospital System, Houston, Texas, the PyTorch_EHR outperformed traditional machine learning methods logistic regression and light GBM (Area Under the Curve of Receiver Operating Curve [AUC]PyTorch_EHR=91.12%, AUCLR=85.91%, AUCLGBM=89.11%). External validation using the MIMIC-IV dataset of 393,713 patient events from a tertiary care center in Boston, Massachusetts, confirmed PyTorch_EHR's accuracy (AUCPyTorch_EHR=85.50%, AUCLR=83.24%, AUCLGBM=82.48%). The model maintained its accuracy across most subgroup analyses based on infection type. The cumulative incidence curves based on our model successfully high-, medium-, and low-risk patients. This study demonstrates the potential of deep-learning models to predict the presence of MRSA-positive cultures to optimize MRSA antimicrobial therapy.
... One of the driving factors leading to that has been some evidence showing an increased incidence of drug-resistant pathogens (DRP) in patients coming from the pneumonia community, including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa [6-15]. Different experiences have been published attempting to identify DRP in CAP through the implementation of probabilistic approaches in clinical practice [16][17][18][19][20][21][22][23][24][25][26][27]. However, recent epidemiological data showed that the incidence of DRP in CAP varies significantly according to local ecology, healthcare systems and countries where the studies were performed [1,28]. ...
... Important differences exist in the prevalence of DRP and the prevalence of each single DRP across different clinical studies worldwide (Table 1) [18,19,[21][22][23][24][25][26][27]74]. MRSA and P. aeruginosa are the most frequently isolated DRP. ...
... MRSA and P. aeruginosa are the most frequently isolated DRP. Studies in culture positive patients that were performed in the USA showed a higher prevalence of DRP, and in particular MRSA, compared to the rest of the world [19,26,74]. European studies showed a lower prevalence of DRP, and the rate of P. aeruginosa or MRSA in CAP seemed to be lower than 6% [21,24,25]. ...
A substantial increase in broad-spectrum antibiotics as empirical therapy in patients with community-acquired pneumonia (CAP) has occurred over the last 15 years. One of the driving factors leading to that has been some evidence showing an increased incidence of drug-resistant pathogens (DRP) in patients from a community with pneumonia, including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Research has been published attempting to identify DRP in CAP through the implementation of probabilistic approaches in clinical practice. However, recent epidemiological data showed that the incidence of DRP in CAP varies significantly according to local ecology, healthcare systems and countries where the studies were performed. Several studies also questioned whether broad-spectrum antibiotic coverage might improve outcomes in CAP, as it is widely documented that broad-spectrum antibiotics overuse is associated with increased costs, length of hospital stay, drug adverse events and resistance. The aim of this review is to analyze the different approaches used to identify DRP in CAP patients as well as the outcomes and adverse events in patients undergoing broad-spectrum antibiotics.
... These risk factors have been computed to create risk prediction models shown to accurately estimate the risk of DRP. In a recent systematic review, 14 published risk prediction methods for DRP were identified, of which eight were externally validated (page 107, supplementary material) [88][89][90][91][92][93][94][95]. They are characterised by high sensitivity and generally low specificity that may favour overtreatment. ...
PurposeSevere community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and whilst European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP.Methods
The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations.ResultsRecommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions.Conclusions
In these international guidelines, ERS, ESICM, ESCMID, and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment, and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.
