Background
Methods
Patients
Definitions
Data and sample collection
Evaluation of the clinical efficacy
Criteria for the identification of bacterial isolates
Microbiological evaluation using cultivation methods
Total cell count, cell lysis efficiency analysis and bacterial identification using the molecular method
Evaluation of the radiologic findings
Statistical analysis
Results
Clinical characteristics and laboratory findings of the participants
Clinical variates | Group A | Group B |
P-value |
---|---|---|---|
Treated with anti-MRSA drugs | Treated without anti-MRSA drugs | ||
(n = 13) | (n = 29) | ||
Age ± SD (years) | 74.8 ± 10.1 | 74.6 ± 17.5 | 0.764 |
Male: Female | 10:3 | 19:10 | 0.458 |
Underlying diseases** | |||
None | 2 (15.4 %) | 4 (13.8 %) | 0.898 |
Malignancies | 1 (7.7 %) | 11 (37.9 %) | 0.016 |
Cerebrovascular disorders | 5 (38.5 %) | 10 (34.5 %) | 0.813 |
Chronic pulmonary diseases | 4 (30.8 %) | 5 (17.2 %) | 0.382 |
COPD | 2 (15.4 %) | 2 (6.9 %) | 0.469 |
Bronchiectasis/NTM | 1 (7.7 %) | 5 (17.2 %) | 0.370 |
Interstitial lung diseases | 1 (7.7 %) | 1 (3.4 %) | 0.621 |
Diabetes mellitus | 4 (30.8 %) | 3 (10.3 %) | 0.178 |
Dementia | 4 (30.8 %) | 6 (20.7 %) | 0.519 |
Heart diseases | 4 (30.8 %) | 5 (17.2 %) | 0.382 |
Hepatic diseases | 1 (7.7 %) | 1 (3.4 %) | 0.621 |
Renal diseases | 1 (7.7 %) | 4 (13.8 %) | 0.550 |
Hematology/Collagen-vascular diseases | 1 (7.7 %) | 4 (13.8 %) | 0.550 |
ECOG performance status 3-4 | 75.0 % (9/12) | 60.0 % (15/25) | 0.371 |
Use of Glucocorticoid**/Immunosuppresant | 1 (7.7 %) | 5 (17.2 %) | 0.37 |
Use of gastric tube | 1 (7.7 %) | 2 (6.9 %) | 0.931 |
Histories/Risks of aspiration | 8 (61.5 %) | 15 (51.7 %) | 0.568 |
Antibiotic therapy in the preceding 90 days | 5 (38.5 %) | 7 (24.1 %) | 0.387 |
History of MRSA detection in the preceding 90 days | 4 (30.8 %) | 5 (17.2 %) | 0.382 |
Type of pneumonia | |||
CAP | 0 (0.0 %) | 2 (6.9 %) | 0.161 |
HCAP | 2 (15.4 %) | 15 (51.7 %) | 0.015 |
HAP | 11 (84.6 %) | 12 (41.3 %) | 0.099 |
Radiologic findings of Chest CT* | |||
Consolidation | 7 (63.6 %) | 12 (41.4 %) | 0.474 |
Bronchopneumonia | 1 (9.1 %) | 9 (31.0 %)) | 0.052 |
Complicated with cavitation/abscess formation | 0 (0.0 %) | 0 (0.0 %) | – |
Complicated with atelectasis | 0 (0.0 %) | 3 (10.3 %) | 0.083 |
Centrilobular nodules (DPB-like) | 0 (0.0 %) | 0 (0.0 %) | – |
Diffuse alveolar shadow (ARDS-like) | 2 (18.2 %) | 0 (0.0 %) | 0.165 |
Bronchiectasis | 1 (9.1 %) | 6 (20.7 %) | 0.239 |
Parapneumonic pleural effusion | 5 (45.5 %) | 3 (10.3 %) | 0.082 |
Comparison between bacterial cultivation and the clone library method of 16S rRNA gene sequencing analysis
Age | Pneumonia type | Sputum | BALF | Prior antibiotics | Treatments | Clinical outcome | |||
---|---|---|---|---|---|---|---|---|---|
Culture | Culture | Clone library analysis | |||||||
Predominant phylotype, % |
S. aureus
| ||||||||
GROUP A | |||||||||
1 | 72 | HAP |
not analyzed
|
MRSA
|
Staphylococcus aureus 97.5 %
|
97.5 %
| ABK | VCM | ineffective |
2 | 70 | VAP |
not analyzed
|
MRSA
|
Staphylococcus aureus 91.8 %
|
91.8 %
| None | TEIC | effective |
3 | 78 | HAP |
MRSA
|
MRSA
|
Staphylococcus aureus 91.0 %
|
91.0 %
| None | ABK | effective |
4 | 77 | HCAP |
MRSA
|
MRSA
|
Staphylococcus aureus 53.1 %
|
51.8 %
| IPM/CS MINO | BIPM, PZFX + CLDM, CZOP + ABK | ineffective |
5 | 65 | HAP |
not analyzed
|
MRSA
|
Staphylococcus aureus 50.0 %
|
50.0 %
| MEPM | MEPM+VCM | effective |
6 | 76 | HAP |
not analyzed
|
MRSA
|
Corynebacterium simulans 41.9 %
|
8.1 %
| None | VCM | ineffective |
7 | 61 | HAP |
S. pneumoniae MRSA
|
MRSA
|
Haemophilus influenzae 35.3 %
|
3.5 %
| MEPM | MEPM + VCM | effective |
8 | 87 | HAP |
MRSA
|
MRSA
|
Corynebacterium spp. 97.8 %
|
2.2 %
| SBT/ABPC | TEIC | effective |
9 | 66 | HAP |
not analyzed
|
H. influenzae, MRSA
|
Haemophilus influenzae 84.0 %
|
1.1 %
| None | IPM/CS + VCM SBT/ABPC | effective |
10 | 82 | VAP |
not analyzed
|
MRSA P. aeruginosa
|
Pseudomonas aeruginosa 94.6 %
|
0.0 %
| IPM/CS | PZFX+VCM | ineffective |
11 | 61 | HCAP |
not analyzed
|
MRSA, Aspergillus fumigatus
|
Streptococcus spp. 90.7 %
|
0.0 %
| DRPM | DPPM PZFX + CLDM/L-AMB + VCM/TAZ/PIPC | ineffective |
12 | 91 | HAP |
MRSA
|
MRSA
|
Streptococcus oralis 58.5 %
|
0.0 %
| MEPM | LZD | effective |
13 | 87 | HAP |
not analyzed
|
MRSA, Neisseria
|
Neisseria perflava 95.5 %
|
0.0 %
| TEIC | TEIC, AMK | effective |
GROUP B | |||||||||
14 | 81 | HAP |
not analyzed
|
MRSA
|
Staphylococcus aureus 100 %
|
100.0 %
| None | DRPM | effective |
15 | 21 | VAP |
not analyzed
|
MRSA
|
Staphylococcus aureus 88.6 %
|
88.6 %
| None | MEPM | effective |
16 | 73 | CAP |
not analyzed
|
MRSA
|
Staphylococcus aureus 60.8 %
|
60.8 %
| None | GRX | effective |
17 | 76 | HCAP |
MRSA P. aeruginosa
|
MSSA
|
Staphylococcus aureus 57.1 %
|
57.1 %
| None | TAZ/PIPC | ineffective |
18 | 81 | HCAP |
MRSA P. aeruginosa
|
no growth
|
Staphylococcus aureus 55.4 %
|
55.4 %
| None | CZOP + CLDM | effective |
19 | 62 | CAP |
MRSA
|
MRSA
|
Staphylococcus aureus 48.7 %
|
48.7 %
| FQ | CPFX | effective |
20 | 80 | HAP |
MRSA
|
MRSA
|
Streptococcus intermedius 56.5 %
|
40.6 %
| None | DRPM | effective |
21 | 76 | HAP |
MRSA
|
MRSA
|
Corynebacterium spp. 25.3 %
|
18.4 %
| TAZ/PIPC | SBT/ABPC | effective |
22 | 22 | HAP |
not analyzed
|
MRSA, A. baumannii
|
Neisseria elongata 81.2 %
|
15.1 %
| TEIC | IPM/CS | effective |
23 | 81 | HCAP |
MRSA
|
MRSA
|
Streptococcus spp. 46.7 %
|
12.0 %
| None | LVFX | effective |
24 | 85 | HAP |
not analyzed
|
MRSA
|
Streptococcus oralis/mitis 37.3 %
|
8.0 %
| CPFX | LVFX | effective |
25 | 83 | HCAP |
MRSA, E. coli
|
MRSA, E. coli
|
Moraxella catarrhalis 69.2 %
|
7.7 %
| None | TAZ/PIPC | effective |
26 | 76 | HAP |
not analyzed
|
K. pneumoniae, MRSA, Proteus mirabilis
|
Corynebacterium simulans 58.4 %
|
1.3 %
| None | TAZ/PIPC | effective |
27 | 85 | HAP |
MRSA
|
MRSA
|
Fusobacterium nucleatum 55.7 %
|
0.0 %
| None | LVFX | effective |
28 | 61 | HCAP |
not analyzed
|
MRSA, B. cepacia, F. mortiferum
|
Rothia spp. 45.2 %
|
0.0 %
| None | MEPM | effective |
29 | 45 | HAP |
not analyzed
|
S. maltophilia, MRSA
|
Enterococcus hirae 25.8 %
|
0.0 %
| None | MEPM | effective |
30 | 74 | HCAP |
P. aeruginosa MRSA
|
P. aeruginosa, MRSA
|
Streptococcus salivarius 43.0 %
|
0.0 %
| None | MEPM | effective |
31 | 80 | HCAP |
not analyzed
|
MRSA
|
Streptococcus spp. 98.9 %
|
0.0 %
| Unknown | LVFX | effective |
32 | 80 | HCAP |
not analyzed
|
MRSA
|
Streptococcus spp. 97.4 %
|
0.0 %
| Unknown | LVFX | effective |
33 | 98 | HCAP |
MRSA
|
not analyzed
|
Streptococcus spp. 78.8 %
|
0.0 %
| Unknown | TAZ/PIPC | effective |
34 | 80 | HCAP |
MRSA
|
oral bacteria
|
Neisseria spp. 55.0 %
|
0.0 %
| LVFX | MEPM | effective |
35 | 82 | HCAP |
not analyzed
|
P. aeruginosa, MRSA, Streptococcus
|
Streptococcus oralis/mitis 70.7 %
|
0.0 %
| Unknown | SBT/ABPC | effective |
36 | 64 | HCAP |
not analyzed
|
P. aeruginosa, MRSA
|
Pseudomonas aeruginosa 97.4 %
|
0.0 %
| None | TAZ/PIPC + LVFX | effective |
37 | 86 | HCAP |
MRSA
|
K. pneumoniae, MRSA
|
Lactobacillus spp. 51.1 %
|
0.0 %
| None | TAZ/PIPC | effective |
38 | 80 | HCAP |
E. coli, MRSA
|
oral bacteria
|
Streptococcus spp. 45.2 %
|
0.0 %
| None | TAZ/PIPC | effective |
39 | 93 | HCAP |
not analyzed
|
MRSA, oral bacteria
|
Corynebacterium spp. 94.3 %
|
0.0 %
| None | LVFX | effective |
40 | 81 | HAP |
not analyzed
|
MRSA, E. coli
|
Haemophilus influenzae 34.5 %
|
0.0 %
| None | TAZ/PIPC | effective |
41 | 73 | HAP |
not analyzed
|
Enterobacter cloacae, MRSA
|
Enterobacter asburiae 70.0 %
|
0.0 %
| None | DRPM | effective |
42 | 74 | HAP |
MRSA
|
Corynebacterium, MRSA
|
Corynebacterium simulans 98.9 %
|
0.0 %
| TAZ/PIPC | TAZ/PIPC | effective |
Correlation of the percentage of clones of S. aureus phylotype and risk factors of MRSA pneumonia
Risk factors (Positive/Negative)** | The percentage of clones of MRSA phylotype (%) | ||
---|---|---|---|
Positive | Negative |
P-value | |
Use of Glucocorticoid**/Immunosuppressant (6/36) | 40.2 ± 41.4 | 19.0 ± 28.3 | 0.305 |
Histories/Risks of aspiration (23/19) | 18.7 ± 33.2 | 25.2 ± 29.2 | 0.422 |
Antibiotic therapy in the preceding 90 days (12/30) | 30.1 ± 40.7 | 17.5 ± 25.7 | 0.391 |
History of pathogens detection in the preceding 90 days* (9/30) | 38.2 ± 35.1 | 15.4 ± 28.9 | 0.105 |