TY  - BOOK
AU  - Shorr, Andrew F
TI  - A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia
SN  - 1471-2334
PY  - 2013///
KW  - *Methicillin-Resistant Staphylococcus aureus/ip [Isolation & Purification]
KW  - *Pneumonia, Staphylococcal/mi [Microbiology]
KW  - *Pneumonia/mi [Microbiology]
KW  - Aged
KW  - Aged, 80 and over
KW  - Community-Acquired Infections/ep [Epidemiology]
KW  - Community-Acquired Infections/mi [Microbiology]
KW  - Cross Infection/ep [Epidemiology]
KW  - Cross Infection/mi [Microbiology]
KW  - Female
KW  - Hospitalization/sn [Statistics & Numerical Data]
KW  - Humans
KW  - Logistic Models
KW  - Male
KW  - Middle Aged
KW  - Pneumonia, Staphylococcal/ep [Epidemiology]
KW  - Pneumonia/ep [Epidemiology]
KW  - Prevalence
KW  - Retrospective Studies
KW  - Risk
KW  - United States/ep [Epidemiology]
KW  - MedStar Washington Hospital Center
KW  - Medicine/Pulmonary-Critical Care
KW  - Journal Article
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 2001 - present
N2  - 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 unlikely to have MRSA; CONCLUSIONS: MRSA represents a cause of pneumonia presenting to the hospital. This simple risk score identifies patients at low risk for MRSA and in whom anti-MRSA therapy might be withheld; METHODS: We identified patients admitted with pneumonia (Apr 2005-Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the presence of MRSA based on logistic regression (two-thirds of cohort) and developed a risk prediction model based on these factors. We validated the model in the remaining population; RESULTS: The cohort included 5975 patients and MRSA was identified in 14%. The final risk score consisted of eight variables and a potential total score of 10. Points were assigned as follows: two for recent hospitalization or ICU admission; one each for age<30 or > 79 years, prior IV antibiotic exposure, dementia, cerebrovascular disease, female with diabetes, or recent exposure to a nursing home/long term acute care facility/skilled nursing facility. This study shows how the prevalence of MRSA rose with increasing score after stratifying the scores into Low (0 to 1 points), Medium (2 to 5 points) and High (6 or more points) risk. When the score was 0 or 1, the prevalence of MRSA was<10% while the prevalence of MRSA climbed to > 30% when the score was 6 or greater
UR  - http://dx.doi.org/10.1186/1471-2334-13-268
ER  -