Staphylococcus aureus Community-Acquired Pneumonia During the 2006 to 2007 Influenza Season

Study objective: Staphylococcus aureus is a cause of community-acquired pneumonia that can follow influenza infection. In response to a number of cases reported to public health authorities in early 2007, additional case reports were solicited nationwide to better define S aureus community-acquired pneumonia during the 2006 to 2007 influenza season. Methods: Cases were defined as primary community-acquired pneumonia caused by S aureus occurring between November 1, 2006, and April 30, 2007. Case finding was conducted through an Emerging Infections Network survey and through contacts with state and local health departments. Results: Overall, 51 cases were reported from 19 states; 37 (79%) of 47 with known susceptibilities involved infection with methicillin-resistant S aureus (MRSA). The median age of case patients was 16 years, and 44% had no known pertinent medical history. Twenty-two (47%) of 47 case patients with information about other illnesses were diagnosed with a concurrent or antecedent viral infection during their illness, and 11 of 33 (33%) who were tested had laboratory-confirmed influenza. Of the 37 patients with MRSA infection, 16 (43%) were empirically treated with antimicrobial agents recommended for MRSA community-acquired pneumonia. Twenty-four (51%) of 47 patients for whom final disposition was known died a median of 4 days after symptom onset. Conclusion: S aureus continues to cause community-acquired pneumonia, with most reported cases caused by MRSA and many occurring with or after influenza. In this series, patients were often otherwise healthy young people and mortality rates were high. Further prospective investigation is warranted to clarify infection incidence, risk factors, and preventive measures. [Ann Emerg Med. 2009;53:358-365.]