Is Methicillin-Resistant Staphylococcus Aureus Colonization Associated with Worse Outcomes in COPD Hospitalizations?

Abstract

BACKGROUND Although methicillin-resistant Staphylococcus aureus (MRSA) colonization is common in chronic obstructive pulmonary disease (COPD) patients, its effect on the course of COPD hospitalization remains unknown. METHODS Records of 160 patients hospitalized at our institution January 1, 2008 to May 1, 2010 with acute exacerbations of COPD who were screened for MRSA were examined and outcomes from their hospitalizations were quantified. RESULTS Of the 160 patients, 33 (20.6%) were MRSA colonized on screening. These patients had similar demographics, spirometry, Charlson Indexes, and APACHE-II scores when compared to patients who were not MRSA colonized (n=127), but MRSA colonized patients had more hospitalizations within the 2 years prior to admission (2 [1-4.8] versus 1 [0-3], p = 0.03). While hospitalized, MRSA colonized patients had a longer length of stay (9 [5.3-15.5] versus 5 [3-7.8] days, p = 0.01) and more antibiotic days (7 [5-10.8] versus 5 [0-7] days, p = 0.01). They were also more likely to receive intensive care (51.5% versus 23.6%, p = 0.01) and to develop respiratory failure that required noninvasive ventilation (56.3% versus 38.2%, p = 0.05). Trends towards increased use of invasive mechanical ventilation and readmission within 30 days were also present. CONCLUSIONS COPD patients colonized with MRSA have longer hospitalizations, require longer courses of antibiotics, and are more likely to require intensive care.