Pneumonia

Neonatal pneumonia caused by S. aureus has been

described for decades, often reported to occur in
community epidemics in infants during the first month
of life. These infections, even before the advent of
CA-MRSA, have been known to cause severe
disease with a high mortality rate that may reflect
virulence of strains circulating at that time
[160,248,249].
In the current era, staphylococcal pulmonary
infections produce many different clinical syndromes,
depending on the pathogen and presence or absence
of underlying lung disease and other comorbidities.
The severity of infection caused by CoNS, as with all
staphylococcal site-specific infections, is less than
that caused by MSSA or CA-MRSA. A lower
respiratory tract infection may occur as a primary
pneumonia as the sole clinical manifestation of
infection caused by S. aureus, with acquisition of the
organism after contact with family members or
hospital staff. Pneumonia may also occur as part of
more generalized, invasive,
disseminated staphylococcal infection. In large series
of neonatal sepsis and bacteremia cases, pneumonia
caused by either CoNS or S. aureus is only rarely
listed as a primary diagnosis, or a complication,
without details provided about the clinical presentation
of lower respiratory tract disease [6,161–163,175].
The infection is often hospital-acquired in a neonate
with underlying lung disease, most commonly chronic
lung disease (bronchopulmonary dysplasia),
especially in infants receiving concurrent mechanical
ventilation.
An early study of staphylococcal pneumonia in the
first month of life was reported from New Zealand in
1956 during an epidemic that primarily caused
cutaneous infection. The eight infants who died of
pneumonia in this epidemic presented at 2 to 3 weeks
of age with irritability and poor feeding noted for a few
days, followed by dyspnea, cough, and fever [248].
Death occurred in these infants 1 to 5 days after
admission, with autopsy findings
documenting empyema, consolidation, and abscess
formation. In a study of community-acquired S.
aureus infection in neonates from Houston, Texas,
from 2001-2005, infants were described who had no
underlying disease, no indwelling catheters, and no
previous hospitalization. Of 89 neonates identified
with S. aureus infection, only 1 had a primary lung
infection, caused by CA-MRSA, producing
a necrotizing pneumonia complicated
by pneumothorax and empyema and requiring video-
assisted thoracoscopic surgery and chest tube
drainage.