Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia

Smith, Melanie; Erdman, Michael; Ferreira, Jason; Aldridge, Petra; Jankowski, Christopher A.

doi:10.1016/j.jcrc.2016.11.008

Cited by 54 publications

(49 citation statements)

References 26 publications

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“…Numerous studies have shown that nasal swab screening for MRSA colonization has a reliably high NPV and effectively identifies patients at low risk for LRTIs caused by MRSA. [6][7][8][9][10] The present study builds on previous data by showing a significant reduction in vancomycin therapy duration in the period after implementation of the CPA allowing pharmacists to order MRSA nasal swab PCR screening, with no significant between-group differences in median time from PCR order to result or MRSA nasal swab positivity rates. Several studies have shown a decrease in duration of therapy with implementation of pharmacistdriven screening test protocols.…”

Section: Discussionsupporting

confidence: 77%

Pharmacist-Driven MRSA Nasal PCR Screening and the Duration of Empirical Vancomycin Therapy for Suspected MRSA Respiratory Tract Infections

Woolever

Schomberg

Cai

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Section: Discussionsupporting

confidence: 77%

Pharmacist-Driven MRSA Nasal PCR Screening and the Duration of Empirical Vancomycin Therapy for Suspected MRSA Respiratory Tract Infections

Woolever

Schomberg

Cai

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…One could postulate that by decreasing the number of days a patient is on vancomycin for MRSA coverage in pneumonia that total healthcare costs would also be decreased because of fewer days in the hospital and less serum vancomycin levels being obtained. According to Smith et al, a $108 reduction in cost per patient was noted in medication-related costs following the implementation of a similar protocol [13].…”

Section: Discussionmentioning

confidence: 99%

Impact of a Pharmacist-driven Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Nasal Swab Protocol on the De-escalation of Empiric Vancomycin in Patients with Pneumonia in a Rural Healthcare Setting

Dadzie

Dietrich

Ashurst

2019

Cureus

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Introduction Pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) carries a high rate of morbidity and mortality. Many clinicians empirically treat those at risk of developing MRSA pneumonia with vancomycin. Several studies have identified a high negative predictive value of the MRSA polymerase chain reaction (PCR) nasal swab test in lower respiratory tract infections, suggesting it can be used to guide the de-escalation of empiric anti-MRSA therapy. Objective To evaluate the impact of a pharmacist-driven MRSA PCR nasal swab protocol on the deescalation of empiric vancomycin in patients with pneumonia in a rural healthcare setting. Secondarily, to assess the rate of hospital length of stay, the rate of vancomycin-associated acute kidney injury, and in-hospital mortality after pharmacist-driven de-escalation of empiric vancomycin in patients with pneumonia.

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“…Of the 52 patients with negative MRSA swabs, only 3 (5.8%) later developed MRSA VAP. Smith and colleagues examined the clinical utility of MRSA nasal swabs before or within 48 hours of ICU admission in patients with nosocomial pneumonia and found a negative predictive value of 99.03% [12]. Patients who were continued on anti-MRSA therapy, specifically vancomycin, despite negative MRSA swab results had a significantly longer ICU length of stay.…”

Section: Limitationsmentioning

confidence: 99%

A Risk Factor Analysis for MRSA Ventilator-Associated Pneumonia to Guide Empiric Therapy in the Surgical Intensive Care Unit

E¹,

E²,

E³

et al. 2019

J Infect Dis Epidemiol

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Background: Methicillin resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) is increasing in prevalence. Treatment of VAP has moved toward ensuring patients are adequately covered for MRSA and other MDROs while balancing the need for antimicrobial stewardship and appropriateness of empiric coverage of these organisms in the setting of increasing resistance rates. The objective of this study was to identify the incidence of and risk factors for MRSA VAP in surgical intensive care unit (SICU) patients as a means to better identify patients at risk who would benefit from MRSA coverage empirically. Methods: This was a single-center, retrospective risk factor analysis of adult SICU patients, comparing patients with MRSA VAP to those with VAP due to alternative pathogens. Primary outcomes were incidence of MRSA VAP and risk factors associated with MRSA VAP. A multivariable logistic regression model was performed to identify risk factors for MRSA VAP. Results: Of 140 included patients, MRSA VAP occurred in 31 (22.1%). Fewer patients in the MRSA group were in septic shock (6.5 vs. 23.9%, p = 0.04) or hemodynamically unstable (16.1 vs. 34.9%, p = 0.03) at the time of VAP diagnosis. A lower proportion of MRSA patients had antibiotic exposure prior to VAP (58.1 vs. 78.9%, p = 0.03). Female sex was associated with a 2.3-fold higher risk for MRSA VAP and history of MRSA with a 4.2-fold higher risk, while patients with prior antibiotic exposure were 60% less likely to develop MRSA VAP. Conclusions: Ventilator-associated pneumonia due to MRSA was common among this SICU cohort. A history of MRSA infection and lack of prior antibiotic exposure may be useful factors to aid in selection of patients appropriate for empiric MRSA therapy. Risk factor analysis may be difficult in this population due inability to control for all patientspecific variables. Future risk factor studies investigating specific MDRO VAPs and the role of dysbiosis are needed to determine the appropriateness of empiric broad-spectrum therapy.

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Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia

Cited by 54 publications

References 26 publications

Pharmacist-Driven MRSA Nasal PCR Screening and the Duration of Empirical Vancomycin Therapy for Suspected MRSA Respiratory Tract Infections

Pharmacist-Driven MRSA Nasal PCR Screening and the Duration of Empirical Vancomycin Therapy for Suspected MRSA Respiratory Tract Infections

Impact of a Pharmacist-driven Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Nasal Swab Protocol on the De-escalation of Empiric Vancomycin in Patients with Pneumonia in a Rural Healthcare Setting

A Risk Factor Analysis for MRSA Ventilator-Associated Pneumonia to Guide Empiric Therapy in the Surgical Intensive Care Unit

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