Evaluating the Role ofStaphylococcus aureusNasal PCR in Pediatric Head and Neck Infections

Abstract

OBJECTIVE Vancomycin is often empirically used in the management of head and neck infections (HNIs) in children. The objective of this study was to determine the utility of Staphylococcus aureus (SA) nasal PCR to facilitate de-escalation of vancomycin for pediatric HNIs. METHODS This was a single-center, retrospective cohort study of pediatric patients who received empiric intravenous vancomycin for a diagnosis of HNIs between January 2010 and December 2019. Subjects were excluded if they met any of the following: confirmed/suspected coinfection of another site, dialysis, immunocompromised status, admission to the NICU, alternative diagnosis that did not require antibiotics, or readmission for HNIs within 30 days of previous admission. The primary outcome was time to de-escalation of vancomycin. Total duration of antibiotics, treatment failure, hospital length of stay (LOS), and incidence of acute kidney injury (AKI) were also assessed. RESULTS Of the 575 patients identified, 124 patients received an SA nasal PCR. The median time to de-escalation was 39.5 hours in those patients compared with 53.7 hours in patients who did not have a SA nasal PCR (p = 0.002). No difference was noted in total duration of all methicillin-resistant Staphylococcus aureus antibiotics, hospital LOS, treatment failure, and AKI. CONCLUSIONS In a large cohort of pediatric patients with HNIs, those who underwent testing with an SA nasal PCR spent less time receiving intravenous vancomycin, although their LOS was not significantly reduced. Further investigation is needed to better define the role of SA nasal PCRs in determining antibiotic therapy for HNIs.

Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship

“…The authors noted no statistically significant difference in readmission rate between patients who had MNS versus those who did not have MNS (P = 0.27). 11 The limitations of this study include its retrospective design and small numbers of patients in the subgroups evaluating specific sites of infection. During the study period, MNS were only ordered at the discretion of the admitting service or recommended by Pediatric Infectious Diseases which may have resulted in some selection bias.…”

“…One retrospective cohort study investigated the utility of MNS specifically for pediatric head and neck infections in 124 patients who received MNS during their admission. 11 In their study, treatment failure was defined as hospital readmission within 30 days of discharge for head and neck infections, like how we defined this in our study. The authors reported a readmission rate of 8.1% (n = 10) in those patients who received MNS versus 3.9% (n = 4) in those patients who did not receive a nasal swab.…”

“…The authors noted no statistically significant difference in readmission rate between patients who had MNS versus those who did not have MNS ( P = 0.27). 11…”