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New concepts in the management of CAP: a focus on severe illness - MRSA and MDR pathogens

Part 2 of 2
Published on May 31, 2022   24 min

A selection of talks on Clinical Practice

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0:05
I've listed here my financial disclosures, which include my consulting arrangements with a number of pharmaceutical companies and research grants. These are disclosures that could be potentially relevant to the presentation today.
0:19
Let's talk about community-acquired MRSA, a pathogen that can occur in community-acquired pneumonia, but one that we need to have a high level of suspicion about, not necessarily treating empirically in everybody, but certainly thinking about in those individuals who have serious illness with necrotizing pneumonia. Generally, community-acquired MRSA is not like nosocomial MRSA and can occur in previously healthy individuals. The clinical features that suggest that a patient is at risk for community-acquired MRSA includes: cavitary pneumonia, rapidly increasing pleural effusion, coughing up blood and recent influenza in an individual who was previously healthy. Probably even more so than those who've been vaccinated for pneumococcus, where pneumococcus would be less likely. These are all things to think about as risk factors for community-acquired MRSA.
1:14
Community-acquired MRSA, as I pointed out, is not the same as nosocomial MRSA. Community-acquired MRSA is a clonal illness. It's commonly associated with the pathogens associated with exotoxin production, particularly the USA300 strain that produces the Panton-Valentine leukocidin, the PVL toxin. It's that toxin production that is so bad for patients with community-acquired MRSA. It's the toxin that is associated with the necrotizing infection. These individuals generally have a higher degree of antibiotic susceptibility than those with nosocomial MRSA. Nosocomial MRSA is not generally associated with toxin production, and is generally not associated with susceptibility to clindamycin and trimethoprim sulfa, which is the case in community-acquired MRSA.

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New concepts in the management of CAP: a focus on severe illness - MRSA and MDR pathogens

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