In the early stages of treating patients with SARS-CoV-2, limited information was available to guide antimicrobial stewardship interventions. The COVID-19 Task Force and Antimicrobial Stewardship Committee, at a 988-bed academic medical center, implemented the use of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab polymerase chain reaction (PCR) testing to assist with the de-escalation of anti-MRSA therapy in patients with suspected superimposed bacterial pneumonia in COVID-19. A retrospective study was conducted to evaluate the impact of MRSA nasal swab PCR testing on the rate of anti-MRSA therapy between 13 April 2020 and 26 July 2020. A total of 122 patients were included in the analysis. Of the patients included in the final analysis, 58 (47.5%) had anti-MRSA therapy discontinued and 41 (33.6%) avoided anti-MRSA therapy completely due to a negative swab result. With the implementation of MRSA nasal swab PCR testing in COVID-19 patients, anti-MRSA therapy was reduced in 81% of patients in this study. In patients who continued with anti-MRSA therapy, nasal swabs were either positive for MRSA or an alternative indication for anti-MRSA therapy was noted. Only three patients in the cohort had MRSA identified in a sputum culture, all of whom had anti-MRSA therapy continued. MRSA nasal swab PCR testing may serve as an effective antimicrobial stewardship tool in COVID-19 pneumonia.
BackgroundEvidence available to guide perioperative antibiotic prophylaxis for endoscopic endonasal (EEN) procedures remains limited. The primary objective of this study was to characterize the impact of antibiotic prophylaxis on the incidence of post-operative central nervous system (CNS) or sinonasal infections in patients undergoing EEN procedures.MethodsThis was an IRB-approved descriptive analysis including patients >18 years of age who underwent EEN surgery at AdventHealth Orlando over a 3-year period. Patients were excluded if they had an infection present prior to surgery, ongoing antibiotic treatment (other than surgical prophylaxis) at the time of surgery, or a basic sinonasal surgery which lacked CNS penetration. The primary endpoint assessed was the rate of CNS or sinonasal infection within 30 days of EEN procedure.ResultsAfter screening 160 patient encounters, a total of 118 patients were included. The most common antibiotic prophylaxis utilized was ceftriaxone, followed by cefazolin, or alternative/combination therapy (72.8% vs. 13.6% vs. 13.6% of cases, respectively). There were 4 total patients who met the primary endpoint, and all 4 cases were due to a diagnosis of meningitis (overall rate 3.4%). Infection rate by antibiotic prophylaxis was 2.4% for ceftriaxone, 0% for cefazolin, and 14.3% for alternative/combination therapy. Based upon the retrospective nature of this study, we were unable to account for provider preference in selection of surgical prophylaxis or other surgeon-specific factors.ConclusionIn this retrospective descriptive analysis, rates of CNS or sinonasal infections occurred at a rate similar to previously published literature. Larger, prospective studies are warranted to evaluate the impact of antibiotic selection on the rate of CNS or sinonasal infections post-EEN procedures.
Disclosures
All authors: No reported disclosures.
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