Shorr Score for MRSA Pneumonia

Why Use

Pneumonia etiology varies for patients admitted for the diagnosis. Previous HCAP definition does not differentiate between drug resistant pathogens such as MRSA and other gram negative bacteria, which have different risk factors and treatments. Can help reduce overtreatment of MRSA pneumonia.

When to Use

Patients >18 years old admitted for pneumonia.

Formula

Pearls / Pitfalls

The Shorr Score for MRSA Pneumonia was developed to assess risk of MRSA pneumonia in admitted patients for whom the reason for admission was pneumonia, in order to determine who might benefit from adding MRSA coverage. Developed specifically to risk-stratify MRSA pneumonia patients, compared to the original health care associated pneumonia (HCAP) definition. Also differentiates between MRSA and drug-resistant gram-negative pneumonia, which HCAP does not.

Management

Options for MRSA treatment include vancomycin, linezolid, and clindamycin.

Advice

Risk factors for MRSA (infection with MRSA in the past year, known colonization, necrotizing or cavitary pneumonia, high severity-of-illness scores e.g. PSI/PORT or APACHE II , preceding or concurrent influenza), should also be taken into account when deciding if MRSA treatment is warranted. Intended to guide the decision of MRSA treatment initiation. Confirmation studies and clinical judgment should be used to decide if continued MRSA treatment is needed.

More Information

Interpretation: Shorr Score Risk for MRSA 0-1 Low risk for MRSA. Consider routine antibiotic coverage. 2-5 Intermediate risk for MRSA. Use clinical judgment regarding antibiotic coverage. 6-10 High risk for MRSA. Consider extended antibiotic coverage.