Download

Download Full Text (1.3 MB)

Description

Background Complicated community-acquired pneumonia (cCAP)—defined by effusion, empyema, abscess, cavitation, or necrosis—is associated with worse outcomes than uncomplicated pneumonia. Methicillin resistant Staphylococcus aureus (MRSA) data in cCAP are limited and often merged with uncomplicated cases. Although guidelines recommend MRSA coverage only in select cases, it is empirically used in >70% of encounters. Lack of pathogen identification likely drives overuse due to diagnostic uncertainty. Clarifying Member of AAP, APA, APS, SPR, ASPN, or PIDS? PIDS JM Jessica Markham, MD, MSc Position: Associate Professor of Pediatrics Organization: Children's Mercy Hospitals and Clinics Email: jlmarkham@cmh.edu Role: Co-Author Disclosure Status: Complete Disclosure: Nothing to Disclose Signed: Jessica Markham, MD, MSc (10/27/2025, 2:10 PM) Part 1 I Agree Professional Status Faculty > 5 yrs Member of AAP, APA, APS, SPR, ASPN, or PIDS? AAP, APA MRSA prevalence, antibiotic-pathogen concordance, and outcomes may reveal stewardship opportunities to reduce unnecessary coverage. Objective We aimed to 1) describe local causative cCAP pathogens, 2) quantify antibiotic-pathogen concordance, and 3) assess adverse events in patients with unknown MRSA status discharged without MRSA coverage. Design/Methods We conducted a single-center chart review of children aged 60 days–18 years hospitalized with cCAP from 2012–2022. We excluded patients with immunodeficiency, congenital heart disease, chronic lung disease, cystic fibrosis, malignancy, or non-physiologic airways. We defined empiric antibiotics as those given before diagnostic tests, post-diagnostic antibiotics as those following test results, and final antibiotics as the last regimen. Outcomes included antibiotic-pathogen concordance, regimen changes, and readmissions. Descriptive statistics were used. Results Of 129 cCAP patients, 119 (92.3%) had pleural effusion/empyema; 117 (90.7%) underwent pleural/abscess fluid drainage. Most had blood (76%) or fluid (90%) cultures; fewer had Streptococcus pneumoniae (47.3%) or S. aureus PCR (43.4%). S. pneumoniae PCR had the highest positivity (Table 1). MRSA coverage was given to 117 (90.7%) patients: 89.9% empirically, 48.8% post-diagnostic, and 40.3% as final regimen. Among 70 cases with identified pathogens, S. pneumoniae was most common (Figure 1); MRSA was found in 7. In >90% of encounters with any MRSA coverage, treatment was either discordant (47%) or given to patients with unknown MRSA status (47%). Among final MRSA regimens, 67.3% were given to patients with unknown MRSA status. (Figure 2). All patients not started on empiric MRSA therapy were discharged without it. Of 61 with unknown status, 6 never received MRSA coverage; 20 were narrowed to non-MRSA antibiotics, with 2 (7.6%) readmitted (1 aspiration pneumonia, 1 fungal infection). Conclusion(s) MRSA positivity was low, yet MRSA antibiotic use was high. No increase in readmissions was seen among those without MRSA coverage, though larger studies are needed to confirm safety and guide patient selection.

Publication Date

4-2026

Disciplines

Pediatrics

When and Where Presented

Presented at the 2026 Pediatric Academic Societies (PAS) Annual Meeting; Boston, MA; April 24-27, 2026.

Antibiotic-Pathogen Concordance in Pediatric Complicated Community-Acquired Pneumonia

Included in

Pediatrics Commons

Share

COinS