Background: Incidences of community-acquired methicillin resistant Staphylococcus aureus (MRSA) infections have increased in the recent years. Little evidence exists whether community-acquired MRSA predisposes to increased incidence of other concurrent infections, especially in high risk groups such as prison inmates.
Case Report: A 34-year-old African American male, recently released from prison, presented to our emergency department complaining of cough with several episodes of coughing up blood and associated weight loss, fever, chills and night sweats. He had a tuberculin skin test in prison which was apparently negative. On presentation he was febrile, tachycardic, orthostatic, tachypnic and hypoxic. Chest radiograph revealed infi ltrates in the right mid and lower lobes and left lower lobe. The patient was admitted to step-down unit with diagnoses of severe sepsis, multilobar pneumonia, and hypovolemic hyponatremia. Sputum cultures later grew MRSA and Pseudomonas aeruginosa. Bronchial aspirate cultures again grew MRSA and Pseudomonas aeruginosa. Bronchial biopsy showed severe inflammation without malignancy. After treatment patient showed dramatic improvement and was discharged.
Conclusions: In this patient without any apparent risk factors for developing healthcare-associated pneumonia, he was found to have co-infection with MRSA and Pseudomonas aeruginosa. While community-acquired MRSA infections have been well-described among prisoners, community-acquired transmission of Pseudomonas aeruginosa infections is uncommonly reported amongst healthy adults. Healthcare providers need to be aware that prison inmates are probably at higher risk of transmission of MRSA. More stringent hand washing amongst high risk populations including prison inmates should be emphasized to prevent widespread transmission of MRSA.

Keywords: community-acquired MRSA, Pseudomonas aeruginosa, prison inmates