A negative nares screen in combination with absence of clinical risk factors can be used to identify patients with very low likelihood of methicillin-resistant Staphylococcus aureus infection in a Veterans Affairs hospital

Clinical Utility of Methicillin‐Resistant Staphylococcus aureus Nasal Screening for Antimicrobial Stewardship: A Review of Current Literature

“…For geographic regions, patient populations, or infection types with higher MRSA prevalence (e.g., SSTI) and lower performance of the MRSA nasal swab (e.g., NPV less than 90%), MRSA nasal screening may be best applied in combination with a scoring tool based on clinical risk factors. One study found negative MRSA nasal screening to have an NPV of 95.7% for any MRSA infection, but the addition of a clinical risk factors assessment (i.e., immunosuppressive agents, homelessness, long‐term care facility residence, SSTI as source, history of incarceration, spinal cord injury, previous MRSA colonization or infection, and both diabetes mellitus and end‐stage renal disease) increased the NPV to 97.7% …”

“…One study found negative MRSA nasal screening to have an NPV of 95.7% for any MRSA infection, but the addition of a clinical risk factors assessment (i.e., immunosuppressive agents, homelessness, long-term care facility residence, SSTI as source, history of incarceration, spinal cord injury, previous MRSA colonization or infection, and both diabetes mellitus and end-stage renal disease) increased the NPV to 97.7%. 23…”

“…A retrospective study of 1246 patients from a VA hospital reported a sensitivity, specificity, PPV, and NPV of 72.1%, 86.8%, 43.7%, and 95.7%, respectively, for predicting any MRSA infection with nasal screening. 23 Another retrospective review of 2908 patients from a VA hospital reported similar performance for MRSA nasal screening with a sensitivity of 74.4%, specificity of 74.0%, PPV of 17.0%, and NPV of 97.6% for predicting MRSA infection. 24 The largest review to date reports results from 326,282 patients from 129 VA hospitals and again finds high performance for MRSA nasal screening with a sensitivity, specificity, PPV, and NPV of 65.1%, 85.7%, 21.8%, and 97.6%, respectively.…”

“…Veterans Affairs (VA) hospitals have rigorous infection control practices that incorporate universal MRSA nasal screening for all patients at the time of hospital admission. A retrospective study of 1246 patients from a VA hospital reported a sensitivity, specificity, PPV, and NPV of 72.1%, 86.8%, 43.7%, and 95.7%, respectively, for predicting any MRSA infection with nasal screening . Another retrospective review of 2908 patients from a VA hospital reported similar performance for MRSA nasal screening with a sensitivity of 74.4%, specificity of 74.0%, PPV of 17.0%, and NPV of 97.6% for predicting MRSA infection .…”

How Can We Optimize Antibiotic Use in the PICU?*

“…Emerging rapid molecular diagnostic techniques hold promise in earlier tailoring of antimicrobial therapy over of traditional methods by more rapidly identifying both the infecting organism as well as antibiotic resistance determinants, allowing earlier prescription of targeted therapy [13]. Screening cultures for methicillin-resistant Staphylococcus aureus (MRSA) may be of benefit in identifying patients at low-risk for invasive MRSA infection, which may allow for more judicious initiation or earlier discontinuation of vancomycin therapy [14]. Finally, and perhaps the most immediately available strategy, collaboration between intensivists and infectious diseases consultants and/or antimicrobial stewardship programs is needed to optimize adherence to existing guidelines for antibiotic treatment choice and duration.…”