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Abstract
Objectives
The objective of this study is to describe the real-world treatment patterns and burden of suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in Saudi Arabia and Lebanon.
Methods
A retrospective chart review study evaluated 2011–2012 data from hospitals in Saudi Arabia and Lebanon. Patients were included if they had been discharged with a diagnosis of MRSA pneumonia, which was culture proven or suspected based on clinical criteria. Hospital data were abstracted for a random sample of patients to capture demographics (eg, age and comorbidities), treatment patterns (eg, timing and use of antimicrobials), hospital resource utilization (eg, length of stay), and clinical outcomes (eg, clinical status at discharge and mortality). Descriptive results were reported using frequencies or proportions for categorical variables and mean and standard deviation for continuous variables.
Results
Chart-level data were collected for 93 patients with MRSA pneumonia, 50 in Saudi Arabia and 43 in Lebanon. The average age of the patients was 56 years, and 60% were male. The most common comorbidities were diabetes (39%), congestive heart failure (30%), coronary artery disease (29%), and chronic obstructive pulmonary disease (28%). Patients most frequently had positive cultures from pulmonary (87%) and blood (27%) samples. All isolates were sensitive to vancomycin, teicoplanin, and linezolid, and only one-third of the isolates tested were sensitive to ciprofloxacin. Beta-lactams (inactive therapy for MRSA) were prescribed 21% of the time across all lines of therapy, with 42% of patients receiving first-line beta-lactams. Fifteen percent of patients did not receive any antibiotics that were considered to be MRSA active. The mean hospital length of stay was 32 days, and in-hospital mortality was 30%.
Conclusion
The treatment for MRSA pneumonia in Saudi Arabia and Lebanon may be suboptimal with inactive therapy prescribed a substantial proportion of the time. The information gathered from this Middle East sample provides important perspectives on the current treatment patterns.
Acknowledgments
The authors thank Monica Katyal for her assistance with data collection and analysis.
Author contributions
Adel F Alothman, Abdulhakeem O Althaqafi, Madonna J Matar, Rima Moghnieh, Nirvana Raghubir, Seema Haider, Caitlyn T Solem, and Jennifer M Stephens contributed to study design. Cynthia Macahilig, Adel F Alothman, Abdulhakeem O Althaqafi, Madonna J Matar, Rima Moghnieh, Thamer H Alenazi, and Fayssal Farahat were involved in data acquisition. Caitlyn T Solem and Shelby Corman undertook data analysis. All authors contributed to data interpretation, manuscript drafting, and approved the final manuscript.
Disclosure
This study was sponsored by Pfizer. Shelby Corman, Jennifer M Stephens, and Caitlyn T Solem are employees of Pharmerit International, who were paid consultants to Pfizer in connection with the development of this manuscript and study design, management, and statistical analysis for the study. Cynthia Macahilig is an employee of Medical Data Analytics, a subcontractor to Pharmerit International, who was a paid consultant to Pfizer in the study design, management, and data collection for the study. Nirvana Raghubir and Seema Haider are employees and shareholders of Pfizer. Adel F Alothman received honoraria for several presentations from Pfizer, MSD, and Al Hikma; received travel support from Pfizer, MSD, Gilead, and Al Hikma to attend symposia; and received honoraria for patient data collection related to this study from Pfizer. Abdulhakeem O Althaqafi received a research grant (RR13/248/J) sponsored by Pfizer and received honoraria for patient data collection related to this study from Pfizer. Fayssal Farahat received honoraria for patient data collection related to this study from Pfizer. Madonna J Matar received travel support for attending meetings and received honoraria for patient data collection related to this study from Pfizer. Rima Moghnieh received honoraria for patient data collection related to this study from Pfizer and sponsorship for attending medical meetings from Pfizer and MSD. Thamer H Alenazi received travel support for attending medical meetings from MSD and Pfizer. The authors report no other conflicts of interest in this work.