Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-06-26T11:31:06.240Z Has data issue: false hasContentIssue false
  • English
  • Français

Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments

Published online by Cambridge University Press:  21 May 2015

Joseph V. Vayalumkal ,
Heather Whittingham ,
Otto Vanderkooi ,
Thomas E. Stewart ,
Donald E. Low ,
Michael Mulvey  and
Allison McGeer
Joseph V. Vayalumkal
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Alberta Children's Hospital, University of Calgary, Calgary, Alta.
Heather Whittingham
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ont.
Otto Vanderkooi
Affiliation:
Departments of Microbiology, University of Toronto, Toronto, Ont.
Thomas E. Stewart
Affiliation:
Interdepartmental Division of Critical Care, Mount Sinai Hospital, University of Toronto, Toronto, Ont.
Donald E. Low
Affiliation:
Departments of Microbiology, University of Toronto, Toronto, Ont.
Michael Mulvey
Affiliation:
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Man.
Allison McGeer*
Affiliation:
Departments of Microbiology, University of Toronto, Toronto, Ont.
*
Department of Microbiology, Mount Sinai Hospital, Rm. 210, 600 University Ave., Toronto ON M5G 1X5; amcgeer@mtsinai.on.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

We report a case of fatal necrotizing pneumonia and sepsis caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in an otherwise well, 48-year-old Canadian man with type 2 diabetes mellitus who had travelled to Texas. Despite therapy that included intravenous antibiotics, intravenous immune globulin and other supportive measures, the patient succumbed to his illness. Recently, CA-MRSA pneumonia has been reported in several countries. The virulence of this organism may in part be related to its ability to produce toxins, such as Panton-Valentine leukocidin. As rates of CA-MRSA increase worldwide, physicians should be aware of the potential for MRSA to cause life-threatening infections in patients presenting to Canadian emergency departments (EDs). Necrotizing pneumonia caused by MRSA must be considered in the differential diagnosis of acute, severe respiratory illness. Early recognition of this syndrome in the ED may help physicians initiate appropriate antibiotic therapy in a timely manner.

Keywords

necrotizing pneumoniaMRSAcommunity-acquired MRSACanada
Type
Case Report • Observation de cas
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 4 , July 2007 , pp. 300 - 303
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Mulvey, M, Chui, L, Ismail, J, et al. Development of a Canadian standardized protocol for subtyping methicillin-resistant Staphylococcus aureus using pulsed-field gel electrophoresis. J Clin Microbiol 2001;39:3481–5.Google Scholar
2.McDougal, L, Steward, C, Killgore, G, et al. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–20.Google Scholar
3.Weber, JT. Community-associated methicillin-resisitant Staphylococcus aureus. Clin Infect Dis 2005;41:S269–72.Google Scholar
4.Enright, M, Day, N, Davies, C, et al. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000;38:1008–15.Google Scholar
5.Naimi, T, LeDell, K, Como-Sabetti, K, et al. Comparison of community and health care associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976–84.CrossRefGoogle ScholarPubMed
6.Carleton, H, Diep, BA, Charlebois, E, et al. Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis 2004;190:1730–8.Google Scholar
7.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–74.Google Scholar
8.Gorak, E, Yamada, S, Brown, J. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999;29:797–800.Google Scholar
9.Francis, J, Doherty, M, Lopatin, U, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis 2005;40:100–7.Google Scholar
10.Frazee, BW, Salz, TO, Lambert, L, et al. Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult. Ann Emerg Med 2005;46: 401–4.Google Scholar
11.Gonzalez, BE, Hulten, KG, Dishop, MK, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus infection. Clin Infect Dis 2005;41:583–90.Google Scholar
12.Janvier, J, Elsayed, S, Gregson, D, et al. Necrotizing pneumonia secondary to community-associated methicillin-resistant S. aureus (CA-MRSA) USA300 strain without evidence of antecedent viral respiratory tract infection. [Abstract]. Can J Infect Dis Med Microbiol 2006;17:30.Google Scholar
13.Monaco, M, Antonucci, R, Palange, P, et al. Methicillin-resistant Staphylococcus aureus necrotizing pneumonia. Emerg Infect Dis 2005;11:1647–8.Google Scholar
14.Peleg, A, Munckhoff, W. Fatal necrotising pneumonia due to community acquired methicillin-resistant Staphylococcus aureus (MRSA). Med J Aust 2004;181:228–9.Google Scholar
15.Dufour, P, Gillet, Y, Bes, M, et al. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis 2002;35:819–24.Google Scholar
16.Barton, M, Hawkes, M, Moore, D, et al. Guidelines for the prevention and management of community-associated methicillin-resistant Staphylococcus aureus: a perspective for Canadian health care practitioners. Can J Infect Dis Med Microbiol 2006; 17(Suppl. C):4C-24C.CrossRefGoogle ScholarPubMed
17.Nicolle, L. Community-acquired MRSA: a practitioner’s guide. CMAJ 2006;175:145–6.Google Scholar
18.Mandell, LA, Bartlett, JG, Dowell, SF, et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003;37:1405–33.Google Scholar
19.File, T, Garau, J, Blasi, F, et al. Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia. Chest 2004;125:1888–901.CrossRefGoogle ScholarPubMed