The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A CASE STUDY OF NECROTIZING MRSA PNA

Farrar Startz1, Koreen Menzies1, Richard M. Ford1



Introduction: This case study is to raise awareness of MRSA necrotizing PNA due to the increasing numbers of cases being seen worldwide. MRSA PNA was first brought into the spotlight in the Flu season of 2003-04 when 15 cases were reported nationwide. According the CDC Morbidity and Mortality weekly report in April of 2007, between December 2006 and January 2007, there were 10 cases of MRSA PNA in previously healthy children and young adults in Louisiana and Georgia alone. Of these 10 cases, six resulted in death. JAMA reported in October 2007, of 8,792 patients with invasive MRSA infections 1,171 were MRSA PNA resulting in a 32.4% mortality rate. The following case study highlights the importance of immediate aggressive respiratory intervention and education with MRSA PNA.

Case Summary: We have gathered critical information pertaining to a 16 year old previously healthy male that presented to the UCSD ED in Feb 2008. The patient complained of flu-like symptoms for the past 2 months with persistent cough and congestion and an increasing constant left sided chest pain for the past 3 to 4 days. The pt was immediately intubated due to hypoxic resp failure with a RA sat of 81% and placed on APRV. The pt was bronched 3 times within the first 24 hours due to poor oxygenation and ventilation. CXR showed complete opacification of bilat lungs and 2 left sided chest tubes were placed for a pneumothorax within 48 hours. Five days after presentation, the pt was placed on HFOV with a PAO2 of 39. Within 10 days of admission, the pt's ETT was changed due to necrotic lung tissue occluding the airway and a right sided chest tube was placed for a pneumothorax on day 14. The patient was managed on HFOV with one brief return to APRV for a possible transition attempt, which was unsuccessful. As the patients lungs began to improve we were able to decrease the HFOV settings and transition him back to APRV on day 22. The patient was liberated from mechanical ventilation to a tracheostomy collar on day 61 and discharged from our hospital into physical rehabilitation on day 103.

Discussion: Although MRSA PNA has a high mortality rate, early and aggressive treatment to support gas exchange using protective strategies such as HFOV and APRV are approaches that were successful. RCP's play a critical role in both the application, support, and management of such difficult cases as well as the liberation of these patients from mechanical ventilation.