Emergence of community-acquired meticillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia

• Published in: The Lancet infectious diseases 2009-06, Vol.9 (6), p.384-392
• Main Authors: Hidron, Alicia I, MD, Low, Cari E, MD, Honig, Eric G, MD, Blumberg, Henry M, MD
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial diseases; Bacterial Proteins - genetics; Bacterial Toxins - genetics; Biological and medical sciences; Clindamycin - therapeutic use; Communicable Diseases, Emerging - drug therapy; Communicable Diseases, Emerging - microbiology; Communicable Diseases, Emerging - physiopathology; Community-Acquired Infections - drug therapy; Community-Acquired Infections - microbiology; Community-Acquired Infections - physiopathology; Drug Resistance, Multiple, Bacterial - genetics; Exotoxins - genetics; Female; Genotype; Human bacterial diseases; Humans; Infectious Disease; Infectious diseases; Intubation, Intratracheal; Leukocidins - genetics; Male; Medical sciences; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Nosocomial infection; Penicillin-Binding Proteins; Pharmacology. Drug treatments; Pneumology; Pneumonia, Staphylococcal - drug therapy; Pneumonia, Staphylococcal - microbiology; Pneumonia, Staphylococcal - physiopathology; Public health; Respiratory system : syndromes and miscellaneous diseases; Risk factors; Staphylococcal infections, streptococcal infections, pneumococcal infections; Toxins; United States; Virulence Factors
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(09)70133-1

Summary Meticillin-resistant Staphylococcus aureus (MRSA), usually known as a nosocomial pathogen, has emerged as the predominant cause of skin and soft-tissue infections in many communities. Concurrent with the emergence of community-acquired MRSA (CA-MRSA), there have been increasing numbers of reports of community-acquired necrotising pneumonia in young patients and others without the classic health-care-associated risk factors. Community-onset necrotising pneumonia due to CA-MRSA is now recognised as an emerging clinical entity with distinctive clinical features and substantial morbidity and mortality. A viral prodrome (eg, influenza or influenza-like illness) followed by acute onset of shortness of breath, sepsis, and haemoptysis is the most frequent clinical presentation. The best treatment of this partly toxin-mediated disease has not been clearly defined. Whereas cases of CA-MRSA pneumonia have now been reported from almost every continent, the overall burden of disease of this emerging syndrome remains incompletely described. We report two related cases of community-onset pneumonia due to the MRSA USA300 genotype and review the literature regarding the emergence of CA-MRSA pneumonia.