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Characterization of Hospitalized Community-Onset Staphylococcus aureus Lower Respiratory Tract Infections Among Generally Healthy Persons 50 Years of Age or Younger

Tosh, Pritish K. MD*†‡; Bulens, Sandra N. MPH; Nadle, Joelle MPH§; Dumyati, Ghinwa MD; Lynfield, Ruth MD; Schaffner, William MD#; Ray, Susan M. MD**††; Jain, Seema MD‡‡; Fridkin, Scott K. MD; Sievert, Dawn M. PhD

Infectious Diseases in Clinical Practice: November 2013 - Volume 21 - Issue 6 - p 359–365
doi: 10.1097/IPC.0b013e3182948d4d
Original Articles

Background Case series have described severe lower respiratory tract infection (LRI) in healthy, community-dwelling persons caused by methicillin-resistant Staphylococcus aureus (MRSA). Evaluating populations at risk is needed.

Methods Surveillance for patients aged 50 years or younger hospitalized with LRI who had S aureus isolated from blood or respiratory specimen during September 2008 to August 2010 was performed at 25 hospitals in 5 US metropolitan areas. Persons with recent health care exposure were excluded. Lower respiratory tract infection diagnosis required supporting radiographic or clinical evidence. Clinical characteristics of LRI were compared by methicillin resistance phenotype.

Results In total, 94 hospitalized community-onset S aureus LRI cases were identified. Lower respiratory tract infection cases were identified in both young adults and children (60%, 35–50 years; and 19%, younger than 17 years), without any seasonality or association with influenza circulation. Among the 94 case patients with LRI, 34 patients (36%) had bacteremia, 36 patients (40%) required ICU admission, and 6 patients (6%) died; proportions were similar between cases with methicillin-susceptible S aureus and MRSA. Lower respiratory tract infection cases with MRSA had longer median length of stay compared with those with methicillin-susceptible S aureus (9 vs. 6 days; P = 0.04). Lower respiratory tract infection cases with evidence of influenza infection had higher mortality compared with LRI cases without influenza infection (31% vs. 2%; P = 0.003). During influenza circulation, 35 (55%) of 64 case patients with LRI were tested for influenza, and 9 (26%) of the 35 case patients tested positive.

Conclusions S aureus LRI occurred in both adults and children, without any seasonality or association with MRSA and with and without evidence of influenza infection, although case fatality was higher among those with evidence of influenza infection.

From the *Epidemic Intelligence Service, and †Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; ‡Division of Infectious Diseases, Mayo Clinic, Rochester, MN; §California Emerging Infections Program, Oakland, CA; ∥University of Rochester, Rochester, NY; ¶Minnesota Department of Health, St. Paul, MN; #Vanderbilt University School of Medicine, Nashville, TN; **Emory University, Atlanta, GA; ††Georgia Emerging Infections Program, Atlanta, GA and ‡‡Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence to: Pritish K. Tosh, MD, Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55901. E-mail:

The authors have no funding or conflicts of interest to disclose.

For PKT, this manuscript represents work performed while employed by the Centers for Disease Control and Prevention.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Diseases Registry.

© 2013 by Lippincott Williams & Wilkins.