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Seattle & King County
401 5th Ave., Suite 1300
Seattle, WA 98104
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Phone: 206-296-4600
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Health Care Providers
Communicable Diseases, Epidemiology and Immunization
February 23, 2008
Influenza-Associated MRSA Pneumonia
Action requested:
- Consider empiric therapy for MRSA pneumonia in patients with severe community acquired pneumonia, particularly when seasonal influenza activity is high.
- When MRSA pneumonia is suspected, consider adding vancomycin or linezolid to empiric treatment of community acquired pneumonia.
- Report deaths among children associated with laboratory-confirmed influenza to Public Health at 206-296-4774.
- In cases of influenza deaths complicated by S. aureus infection, ask the clinical laboratory to hold the S. aureus isolate for testing at CDC after consultation with Public Health.
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Background:
Influenza infection can predispose to bacterial co-infection. Over the past 5 years in the U.S. there have been increasing reports of community acquired pneumonia due to MRSA, including among otherwise healthy persons with no risk factors for MRSA infection. During that time, strains of MRSA that carry a toxin (Panton-Valentine leukocidin) associated with both skin and soft tissue infections and necrotizing pneumonia have increased across the U.S.
Seasonal influenza activity is at typical peak levels locally, therefore health care providers should consider MRSA pneumonia in patients with influenza-associated pneumonia and severe community acquired pneumonia preceded by influenza-like illness. Clinical features associated with MRSA pneumonia include hypotension/shock, bloody sputum, necrotizing pneumonia, high fever. Both leucopenia and leukocytosis have been reported.
References
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