Pneumonia caused by coagulase-positive methicillin-resistant Staphylococcus aureus

Biljana Lazović; Radmila Dmitrović; Isidora Simonović; Nevena Jovičić; Sanja Šarac; Rade Milić; Vuk Aleksić

doi:10.2298/VSP200808009L

Biljana Lazović Clinical Hospital Center Zemun, Department of Pulmonology, Belgrade, Serbia
Radmila Dmitrović Clinical Hospital Center Zemun, Department of Pulmonology, Belgrade, Serbia
Isidora Simonović Clinical Hospital Center Zemun, Department of Pulmonology, Belgrade, Serbia
Nevena Jovičić University Children’s Hospital, Belgrade, Serbia
Sanja Šarac Military Medical Academy, Pulmonology Clinic, Belgrade, Serbia
Rade Milić Military Medical Academy, Pulmonology Clinic, Belgrade, Serbia
Vuk Aleksić Clinical Hospital Center Zemun, Department of Pulmonology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP200808009L

Keywords: antibiotics, bronchoscopy, coagulase, methicillin resistance, pneumonia, staphylococcus aureus

Abstract

Introduction. Staphylococcus (S.) aureus is one of the most omnipresent and dangerous human pathogens, whose main characteristic is the production of the enzyme coagulase. This characteristic serves to identify and assess the patho-genicity of the bacteria. In addition to skin infections, endo-carditis, osteomyelitis, and infectious arthritis, it is a com-mon cause of pneumonia both in children and adults. Case report. We described a case of a 65-year-old woman with a dry cough and malaise with patchy areas of consolidation on the chest X-ray and “ground-glass” opacity with bronchial wall thickening and unilateral mediastinal lymphadenopathy on chest computed tomography imaging. Methicillin-resistant S. aureus was isolated from the bronchoalveolar as-pirate taken during bronchoscopy. The woman was empiri-cally treated with azithromycin, and later, based on the anti-biogram findings, azithromycin was replaced with mero-penem, after which her health improved. Conclusion. We presented a rare case of pneumonia with unconvincing symptomatology and laboratory and radiological findings. Paying more attention to such cases in the future is crucial, especially to the use of antibiotics to which staphylococci are increasingly developing resistance.

References

1. Bush LM, Vasquez- Pertejo MT. Staphylococcal infections. MSD MANUAL Professional version. Available from: https://www.msdmanuals.com/en-jp/professional/infectionu s-diseases/gram-positive-cocci/staphylococcal-infections# [last modified March 2021].

2. Berger-Jekić O, Dinić M, Đukić S, Jelesić Z, Kocić B, Kulauzov M, et al. Medical bacteriology. Belgrade: Savremena administracija; 2008. (Serbian)

3. McEachern R, Campbell GD Jr. Hospital-acquired pneumonia: epidemiology, etiology, and treatment. Infect Dis Clin North Am 1998 Sep; 12(3): 761–79, x.

4. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial in-fections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27(5): 887‒92.

5. Carleton HA, Diep BA, Charlebois ED, Sensabaugh GF, Perdreau-Remington F. Community-adapted methicillin-resistant Staphy-lococcus aureus (MRSA): population dynamics of an expand-

ing community reservoir of MRSA. J Infect Dis 2004; 190(10): 1730‒8.

6. Center for Disease Control and Prevention. Community asso-ciated MRSA. Information from the US Centers for Disease Control and Prevention. Available from: http://www.cdc gov/ncidod/hip/ARESIST/mrsa_comm_faq.htm [accessed 2005 July 31].

7. Jacobs DM, Shaver A. Prevalence of and outcomes from staphylo-coccus aureus pneumonia among hospitalized patients in the United States, 2009-2012. Am J Infect Control 2017; 45(4): 404‒9.

8. Santos JW, Nascimento DZ, Guerra VA, Rigo Vda S, Michel GT, Dalcin TC. Community-acquired staphylococcal pneumonia. J Bras Pneumol 2008; 34(9): 683‒9. (English, Portuguese)

9. Carrillo-Marquez MA, Hulten KG, Hammerman W, Lamberth L, Mason EO, Kaplan SL. Staphylococcus aureus pneumonia in children in the era of community-acquired methicillin-resistance at Texas Children's Hospital. Pediatr Infect Dis J 2011; 30(7): 54550.

10. Lewis SS, Walker VJ, Lee MS, Chen L, Moehring RW, Cox CE, et al. Epidemiology of methicillin-resistant Staphylococcus aure-us pneumonia in community hospitals. Infect Control Hosp Epidemiol 2014; 35(12): 1452‒7.

11. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, Albercth V, Limbago B, et al. MERGEncy ID NET Study Group. Preva-lence of Methicillin-resistant Staphylococcus aureus as an eti-ology of community-acquired pneumonia. Clin Infect Dis 2012; 54(8): 1126‒33.

12. Chen J, Luo Y, Zhang S, Liang Z, Wang Y, Zhang Y, et al. Com-munity-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin in a Chinese teenager: case report and literature re-view. Int J Infect Dis 2014; 26: 17‒21.

13. Liu CW, Lin SP, Wang WY, Huang YH. Influenza With Com-munity-Associated Methicillin-Resistant Staphylococcus Aure-us Pneumonia. Am J Med Sci 2019; 358(4): 289‒93.

14. Thomas R, Ferguson J, Coombs G, Gibson PG. Community-acquired methicillin-resistant Staphylococcus aureus pneumo-nia: a clinical audit. Respirology 2011; 16(6): 926‒31.

15. Morikawa K, Okada F, Ando Y, Ishii R, Matsushita S, Ono A, et al. Meticillin-resistant staphylococcus aureus and meticillin-

susceptible S. aureus pneumonia: comparison of clinical and thin-section CT findings. Br J Radiol 2012; 85(1014): e168‒75.

16. González C, Rubio M, Romero-Vivas J, González M, Picazo JJ. Staphylococcus aureus bacteremic pneumonia: differences be-tween community and nosocomial acquisition. Int J Infect Dis 2003; 7(2): 102‒8.

17. File TM Jr. Treatment of community-acquired pneumonia in adults who require hospitalization. Available from: https://www.uptodate.com/contents/treatment-of-communit y-acquired-pneumonia-in-adults-who-require-hospitalization# H4033052510 [updated 2021 September 3].

18. Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-resistant staphylococ-cus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis 2012; 54(5): 621‒9.

19. Kaysin A, Viera AJ. Community-acquired pneumonia in adults: diagnosis and management. Am Fam Physician 2016; 94(9): 698‒706.