H1N1 plus MRSA

[Mammy1111]

Does anyone know of good articles about H1N1 with compicating MRSA pneumonia? I saw Dr Jain on CNN yesterday and he spoke of this complication that apparently is very deadly. It is not surprising, but the sad thing is that is is effecting children and young adults. He went so far as to recommend that if a flu patient presents with difficulty breathing and a very high WBC, that the doctor should consider starting Vancomycin immediately. This makes sense to me since a patient can go downhill very quickly with MRSA pneumonia.

I don't understand why this information or a form of it isn't a widespread warning for anybody with the flu who has persistant difficulty breathing or fevers. CDC needs to get the word out and give warnings that H1N1 complications can include deadly MRSA pneumonia and people should not ignore the warning signs.

[WalkieTalkie, RN]

Actually, if your hospital does core measures (CMS requirement), they should be getting abx upon admission for probable pneumonias.

Many hospitals are utilizing forms such as this one: http://www.caromont.org/workfiles/physician%20forms/1246.doc

I know at my workplace, we always give vanco patients who come from LTCs, other hospitals, or have been recently hospitalized. Was the doc referring to CA-MRSA, or nosocomial co-infections?

[Mammy1111]

The doctor did not specify CA or nosocimial MRSA. He was addressing patients presenting with SOB, high fever and high WBCs. I felt that his point was the importance of getting it right and getting it quickly rather than where the MRSA came from. And this makes sense. Thank you for the CMO. It appears that coninfections are covered by that order, but only if all providers are aware of this measure. Blood cultures can be negative with MRSA/H1N1 pneumonia, so although important, it seems the sputum gram negative microscopic is the most important thing here when diagnosing the bacterial coinfection....in particular MRSA.

Thanks for your response. I learn more all the time about MRSA and it's effects and treatment.

[WalkieTalkie, RN]

It seems like most of the docs at my hospital are prescribing vanco right now, even to people who wouldn't normally be thought of high-risk MRSA patients. I think it has a lot to do with the increase in the prevalence of CA-MRSA, among other things.

I agree, most of the blood cultures never pan out, sputum is definitely more indicative of what's going on. Most of my patients will grow something in their sputum.

The CDC is also recommending people who are not in the normal target population to get the Pneumovax right now due to H1N1 patients who are dying of secondary pneumonias.