Burden of methicillin-resistant Staphylococcus aureus pneumonia among hospitalized patients in Lebanon and Saudi Arabia

Figures & data

Table 1 Patient profile – MRSA pneumonia

	Overall, N=93	Saudi Arabia, N=50	Lebanon, N=43
Male, %	60	64	56
Age at hospital admission, mean ± SD	56.0±26.8	56.1±26.0	55.9±28.0
Weight at hospital admission, kg
Patients with information, n	67	38	29
Mean ± SD	63.5±25.4	61.9±24.1	65.6±27.2
Body mass index, mg/m^2
Patients with information, n	44	29	15
Mean ± SD	26.0±5.8	25.8±6.3	26.4±4.8
Number of reported comorbidities, mean ± SD	2.5±2.0	2.5±2.0	2.4±1.9
Diabetes, %	39	38	40
Congestive heart failure, %	30	26	35
Coronary artery disease, %	29	22	37
Chronic pulmonary disease, %	28	20	37
Cerebrovascular disease, %	18	22	14
Peripheral vascular disease, %	9	10	7
Dementia, %	8	12	2
Moderate-to-severe renal disease, %	8	4	12
MRSA pneumonia symptoms, %
Fever	65	52	79
Hypothermia	12	16	7
Respiratory rate >30 breaths/min	47	66	26
Systolic hypotension	29	28	30
Heart rate >120 beats/min	46	54	37
Elevated peripheral WBC >10,000/mm^3	76	74	79
Leukopenia with total WBC <4,500 cells/mm^3	6	2	12
Elevated appropriate inflammatory markers (eg, PCT or CRP)	59	34	88
Cultures taken to confirm MRSA, %	97	100	93
Any positive MRSA culture, %a	91	100	80
1 positive culture	57	66	45
2 positive cultures	19	12	28
3+ positive cultures	16	22	8
Site of culture, %a,b
Pulmonary	79	90	65
Blood	24	18	33
Nasal	14	20	8
Other (pus, urine, catheter tip)	5	8	3
Timing of MRSA infection,%
Community-acquired pneumonia	20	14	28
Health-care-associated pneumonia	32	30	35
Nosocomial pneumonia	35	44	26
Unknown	12	12	12

Notes:

a Denominator is patients with a culture taken to confirm MRSA.

b Patients may have had MRSA confirmed by more than one type of culture. Groups not mutually exclusive.

Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; SD, standard deviation; WBC, white blood cell; PCT, procalcitonin; CRP, C-reactive protein.

Table 2 MRSA pneumonia susceptibility profile

Antibiotics	N tested	% sensitive
Vancomycin	80	100
Teicoplanin	32	100
Linezolid	10	100
Rifampin	29	76
Erythromycin	12	75
Gentamicin	8	75
Fusidic acid	9	67
Moxifloxacin	3	67
Levofloxacin	16	63
Trimethoprim/sulfamethoxazole	53	66
Clindamycin	73	53
Tetracycline	4	50
Tigecycline	4	50
Ciprofloxacin	18	33
Beta-lactam antibiotic	54	15

Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.

Figure 1 Medications utilized for MRSA pneumonia treatment.

Notes: Medications are not mutually exclusive. Patients could have received multiple antibiotics during a single-line therapy.

Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.

Figure 2 Length of stay (LOS) among patients with MRSA pneumonia.

Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.

Table 3 MRSA pneumonia clinical outcomes

Outcome	Overall, N=87,%	Saudi Arabia, N=49, %	Lebanon, N=38, %
Clinical response at discharge
Cure (resolution of all signs and symptoms/improvement to such an extent that further antimicrobial therapy was not necessary)	41	54	26
Improvement (improvement in signs and symptoms)	24	10	40
Failure (persistence, incomplete clinical resolution, or worsening in signs and symptoms)	27	28	26
Indeterminate (inability to determine an outcome)	9	8	9
In-hospital mortality	30	34	26
Cause of deatha
Underlying disease-related complication	54	71	27
MRSA related	32	18	55
Cardiac arrest	7	12	0
Another hospital-acquired pneumonia	4	6	0
Other	18	29	0
Unknown	11	6	18
Outcomes 30 daysb post-discharge
Relapse of MRSA pneumonia	3	3	3
Rehospitalization for MRSA pneumonia	2	3	0
Rehospitalization, any reason	20	21	19

Notes:

a Multiple causes of death could be listed.

b only measured in patients who survived to discharge (n=65; Saudi Arabia =33 and Lebanon =32).

Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.