• Gregory J Moran, Anusha Krishnadasan, Rachel J Gorwitz, Greg E Fosheim, Valerie Albrecht, Brandi Limbago, David A Talan, and EMERGEncy ID NET Study Group.
• Department of Emergency Medicine, David Geffen School of Medicine at the University of California at Los Angeles (UCLA), Olive View-UCLA Medical Center, Sylmar, CA, 91342, USA. gmoran@ucla.edu
• Clin. Infect. Dis. 2012 Apr 1; 54 (8): 1126-33.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infections. Recent case series describe severe community-acquired pneumonia (CAP) caused by MRSA, but the prevalence and risk factors are unknown.MethodsWe prospectively enrolled adults hospitalized with CAP from 12 university-affiliated emergency departments during the winter-spring of 2006 and 2007. Clinical information and culture results were collected, and factors associated with MRSA were assessed.ResultsOf 627 patients, 595 (95%) had respiratory (50%) and/or blood cultures (92%) performed. A pathogen was identified in 102 (17%); MRSA was identified in 14 (2.4%; range by site, 0%-5%) patients and in 5% of patients admitted to the intensive care unit. Two (14%) MRSA pneumonia patients died. All 9 MRSA isolates tested were pulsed-field type USA300. Features significantly associated with isolation of MRSA (as compared with any other or no pathogen) included patient history of MRSA; nursing home admission in the previous year; close contact in the previous month with someone with a skin infection; multiple infiltrates or cavities on chest radiograph; and comatose state, intubation, receipt of pressors, or death in the emergency department.ConclusionsMethicillin-resistant Staphylococcus aureus remains an uncommon cause of CAP. Detection of MRSA was associated with more severe clinical presentation.

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