Announcement

Collapse
No announcement yet.

PLoS One: Koinfektion mit c-MRSA bei ambulant erworbener Pneumonie durch pandemische H1N1 Influenza in zwei australischen Krankenh?usern

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • PLoS One: Koinfektion mit c-MRSA bei ambulant erworbener Pneumonie durch pandemische H1N1 Influenza in zwei australischen Krankenh?usern

    PLoS One: Koinfektion mit c-MRSA bei ambulant erworbener Pneumonie durch pandemische H1N1 Influenza in zwei australischen Krankenh?usern

    Hintergrund: Bakterielle Pneumonien sind als Komplikationen einer pandemischen H1N1 Influenza bereits beschrieben worden. In den letzten Jahren sind ambulant erworbene MRSA-Infektionen als Kofaktor f?r die Morbidit?t und Mortalit?t von Influenzainfektionen zunehmend in Erscheinung getreten. Seit dem Ausbruch und der raschen Verbreitung der pandemischen Influenza H1N1 im April 2009 haben die ersten Beschreibungen ?ber die klinischen Charakteristika von bakteriellen Pneumonien bei hospitalisierten Patienten wenige Einzelheiten ?ber bakterielle Koinfektionen beinhaltet.

    Methode und Ergebnisse: Patienten mit ambulant erworbenen Pneumonien, verursacht durch eine Koinfektion von pandemischer Influenza H1N1 und ambulant erworbenem MRSA (cMRSA) wurden prospektiv in zwei Krankenh?usern einer australischen Stadt zwischen Juli und September 2009 identifiziert, also in der Zeit der h?chsten Influenza-Aktivit?t in dieser Region. Bei den cMRSA-Isolaten wurden Zusatzuntersuchungen durchgef?hrt. Von den insgesamt 252 wegen pandemischer Influenza H1N1 in den beiden Krankenh?usern hospitalisierten Patienten dieser Region wurden drei F?lle einer Koinfektion mit cMRSA identifiziert. Die drei Patienten erhielten eine ad?quate empirische Therapie in Bezug auf die pandemische Influenza, jedoch nicht in Bezug auf die MRSA-Infektion. Alle drei Patienten ?berlebten. Zus?tzlich zu diesen F?llen wurden zwei t?dlich verlaufende F?lle von ambulant erworbener Pneumonie durch pandemische Influenza H1N1 mit cMRSA-Koinfektion erst durch die postmortale Untersuchung aufgedeckt.

    Verursacht waren die cMRSA-Infektionen durch drei verschiedene MRSA-St?mme, von denen nur ein einziger das Panton-Valentine Leukocidin (PVL)-Gen enthielt.

    Schlussfolgerung: Klinisch t?tige ?rzte die Patienten mit pandemischer Influenza H1N1 betreuen, sollten die M?glichkeit einer gleichzeitigen oder nachfolgenden Infektion mit resistenten bakteriellen Keimen, wie zum Beispiel cMRSA in Betracht ziehen. MRSA-Pneumonien werden nicht nur durch MRSA-St?mme mit dem PVL-Toxin verursacht.

    Credits to tetano:



    Background Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA) infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N1)2009 influenzavirus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection. Methodology/Principal Findings Patients with community–acquired pneumonia (CAP) caused by co-infection with pandemic A(H1N1)2009 influenzavirus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N1)2009 influenzavirus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N1)2009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N1)2009/cMRSA co-infection were identified on post–mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL). Conclusions/Significance Clinicians managing patients with pandemic A(H1N1)2009 influenzavirus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic A( H1N1) 2009 influenzavirus co-infection.



    Community-Acquired Pneumonia Due to Pandemic A(H1N1)2009 Influenzavirus and Methicillin Resistant Staphylococcus aureus Co-Infection

    Ronan J. Murray1*, James O. Robinson2, Jodi N. White3, Frank Hughes3, Geoffrey W. Coombs2, Julie C. Pearson2, Hui-Leen Tan2, Glenys Chidlow1, Simon Williams1, Keryn J. Christiansen2, David W. Smith1

    1 Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia, 2 Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia, 3 Division of Forensic Pathology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia


    Abstract

    Background
    Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA) infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N1)2009 influenzavirus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection.

    Methodology/Principal Findings
    Patients with community?acquired pneumonia (CAP) caused by co-infection with pandemic A(H1N1)2009 influenzavirus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N1)2009 influenzavirus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N1)2009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N1)2009/cMRSA co-infection were identified on post?mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL).

    Conclusions/Significance
    Clinicians managing patients with pandemic A(H1N1)2009 influenzavirus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic A( H1N1) 2009 influenzavirus co-infection.
Working...
X