Community-acquired staph pneumonia appears more common, including MRSA

Mar 19, 2008

Preliminary research from the Centers for Disease Control and Prevention (CDC) suggests that community acquired pneumonia (CAP) caused by the Staphylococcus aureus bacterium may be more common than originally suspected, including that caused by antibiotic resistant strains. Researchers report their findings today (March 19) at the 2008 International Conference on Emerging Infectious Diseases in Atlanta, Georgia.

“Over the last few years we have been receiving reports of a severe CAP caused by S. aureus. There are a lot of questions about this disease, but until now there have primarily been case studies which tend to highlight the severest of cases and may present a biased picture,” says Alexander Kallen, a lead researcher on the study.

To get a better perspective on the disease Kallen and his colleagues focused on 3 pediatric hospitals in the Atlanta area during the 2006-2007 influenza season and conducted surveillance for S. aureus CAP. They identified 53 cases, a higher number than they had expected.

“No one really knows what the true incidence of S. aureus CAP is. People suspect that S. aureus causes 3%-5% of all CAP cases, but the number of cases per month we found suggest that these rates of S. aureus CAP might be higher than previously estimated,” says Kallen.

In addition, the data also suggest that the case-fatality rate may be lower than the rate reported in recent case series which have been between 30% and 50%. Kallen’s study reports a case-fatality rate of about 13% which is much lower than previous estimates.

The researchers also looked at antibiotic resistance.

“One thing that concerns us is methicillin-resistant S. aureus (MRSA) increasing in the community,” says Kallen.

As with mortality, they found while the proportion of S. aureus CAP cases caused by MRSA was lower than the case series, it was still significant. Approximately half of the S. aureus CAP cases were caused by MRSA, compared to 70%-80% suggested by recent case series.

“Our study found about half the patients had MRSA, which is not unexpected but quite concerning,” says Kallen.

Even more concerning to Kallen was the fact that close to 40% of the children with MRSA CAP were not given antibiotics that covered the resistant strain.

“The fact that a lot of these kids who had MRSA were not treated with antibiotics that have activitity against MRSA suggests that clinicians are not recognizing this organism as a cause of CAP during influenza season,” says Kallen.

Kallen notes that this study is just the first step in a progression towards a better understanding of the patterns of this disease. Much more surveillance is necessary before a clear picture can develop.

Source: American Society for Microbiology

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pharmadoc
not rated yet Mar 19, 2008
Great article today on pneumonia. I am curious about this story from a different angle and that is with the FDA? Why are they holding meetings for setting up new clinical trial design for pneumonia on April 1 and 2 to see if they should change the design and make it more difficult for companies to go through more trials beyond non-inferiority designs?

I read a story the other day about how big drug companies abandoned new antibiotic development because people take them for short periods of time and they would prefer to develop new drugs that people will take forever. I don't know if we need more E.D. and R.L.S.(restless leg syndrome) drugs, but I do know we desperately need a few good new antibiotics.

If you see the news around the country it is quite shocking how many young and otherwise healthy people are dying each day from pneumonia and MRSA because existing antibiotics don't work. If we don't have enough problems with getting new antibiotics approved now they want to see if they should hold more trials to see how new antibiotics would compare to a placebo? In your story today it says 13% of the people are dying? That's a high number to me and I assume it's going to grow.

Small biotechs have been working on new antibiotics that have proven to be as safe and effective or better than the current standard of care treatment antibiotic, yet the FDA now wants to hold meetings to decide if they should add another year or two of reviewing new antibiotics in new clinical trials? I can't imagine their reasoning? I can't imagine how many more people will die while the FDA has more meetings? This new meeting has already delayed reviewing any new antibiotics for treating pneumonia. I also don't see how they can hold trials comparing it to a placebo when people are dying getting the best antibiotics available? Would you want to be the one getting the placebo?

Many people are asking Congress to push through a bill giving big drug companies incentives, tax breaks, etc for them to develop new antibiotics??? This is also crazy. Antibiotic sales in the world are $35 BILLION per year and anti-infectives are $67 Billion a year! What the government needs to do is just give some of these small biotechs a break. It costs them hundreds of millions of dollars to go through the clinical trial process as it is and they run out of money. All they want is a little support not resistance.