Systematic Review of the Clinical Utility of Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) Nasal Screening for MRSA Pneumonia

Smith, Melanie; Brotherton, Amy; Lusardi, Katherine; Tan, Carrie; Hammond, Drayton A.

doi:10.1177/1060028018823027

Cited by 31 publications

(19 citation statements)

References 44 publications

(149 reference statements)

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“…Similar to other studies that describe the validity of MRSA nasal screens, our sensitivity was low at 75% while specificity was high at 100%. However, our PPV of 100% differs from the PPV seen in other studies, which are generally <50% 6,[10][11][12][13]19. Both NPV and PPV are related to the prevalence of the disease state being analyzed (in this case MRSA pneumonia).…”

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confidence: 84%

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Utility of methicillin‐resistant Staphylococcus aureus (MRSA) nasal screening in patients with acute myeloid leukemia (AML)

Talagtag

Patel

Scappaticci

et al. 2021

Transplant Infectious Dis

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Background: Current literature has demonstrated the utility of the MRSA nasal screen as a de-escalation tool to decrease unnecessary anti-MRSA antibiotic therapy.However, data on the applicability of this test in patients with hematologic malignancy is lacking.Methods: This is a single-center, retrospective cohort study of patients with acute myeloid leukemia (AML) with or without a history of hematopoietic cell transplant (HCT), with pneumonia and MRSA nasal screening with respiratory cultures obtained.The primary outcome was to determine the negative predictive value (NPV) of the MRSA nasal screen for MRSA pneumonia. Secondary outcomes included sensitivity, specificity, positive predictive value (PPV) of the MRSA nasal screen and prevalence of MRSA pneumonia.Results: Of 98 patients with AML and pneumonia, the prevalence of MRSA pneumonia was 4.1% with confirmed positive MRSA respiratory cultures observed in 4 patient cases. In patients with confirmed MRSA pneumonia, 3 had positive MRSA nasal screens while 1 had a false negative result, possibly due to a long lag time (21 days) between MRSA nasal screen and pneumonia diagnosis. Overall, the MRSA nasal screen demonstrated 75% sensitivity and 100% specificity, with a PPV of 100% and a NPV of 98.9%. Conclusions:Given the low prevalence, empiric use of anti-MRSA therapy in those AML and HCT patients with pneumonia may not be warranted in clinically stable patients. For patients in whom empiric anti-MRSA antibiotics are initiated, nasal screening for MRSA may be utilized to de-escalate anti-MRSA antibiotics in patients with AML with or without HCT.

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confidence: 84%

“…This high PPV is likely attributed to our smaller sample size with a very low number of positive MRSA nasal screens (3/98). match this NPV 10,19,32. As previously mentioned, both PPV and NPV are affected by prevalence, in which prevalence has an inverse relationship with NPV.…”

mentioning

confidence: 53%

Utility of methicillin‐resistant Staphylococcus aureus (MRSA) nasal screening in patients with acute myeloid leukemia (AML)

Talagtag

Patel

Scappaticci

et al. 2021

Transplant Infectious Dis

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“…These practices are recommended by the Centers for Disease Control and Prevention . Two‐thirds of respondents also use a negative methicillin‐resistant Staphylococcus aureus swab result to reduce the duration of vancomycin therapy, which is a practice supported by emerging evidence in patients with suspected pneumonia . There appears to be an opportunity for most institutions to incorporate clinical decision support systems into management of patients on combination VPT, as less than 10% of respondents indicated providers are alerted to the risk of AKI.…”

Section: Discussionmentioning

confidence: 99%

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Hammond

Trivedi

Esmero

et al. 2019

J Am Coll Clin Pharm

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Purpose To elucidate the considerations pharmacists have when using concomitant vancomycin and piperacillin/tazobactam (VPT) and strategies implemented across hospitals in response to published data on this phenomenon. Methods A survey of pharmacist members of the infectious diseases and critical care (CC) practice and research networks of the American College of Clinical Pharmacy was conducted. Participants were grouped based on their belief (yes or no) in the association between VPT and acute kidney injury (AKI) and queried regarding AKI with VPT, antimicrobial stewardship practices, and demographics. Descriptive statistics were performed. Between‐group responses were compared using χ2 or Fisher's exact tests. Results There were 238 responses. Most (88.7%) respondents believed combination VPT is associated with greater expected odds of AKI development than vancomycin monotherapy or with cefepime. Nonbelievers more commonly practiced in CC or emergency medicine (P = .006) and less frequently recommended the combination in patients already experiencing AKI (64% vs 7.4%, P < .001) and in patients with chronic kidney disease class III or IV (56.9% vs 3.7%, P < .001). Opinions varied regarding risk factors for and odds of AKI development in specific scenarios. Respondents who believed combination VPT is associated with greater odds of AKI development more frequently provided formal (18% vs 0, P = .01) and informal (73% vs 33.3%, P < .001) education on potential AKI from combination VPT and discouraged empiric combination VPT in favor of other combination(s) (40.8% vs 14.8%, P = .01). Other AMS strategies were used to a similar extent regardless of belief in the association of VPT with AKI. Conclusion Most respondents, particularly those practicing in CC and emergency medicine, believe combination VPT is associated with AKI development. These beliefs have affected antimicrobial recommendations and educational efforts. The impact of these beliefs on patient outcomes and health care expenditures requires further investigation.

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“…PCR has poor positive predictive value (PPV) for the diagnosis of CA-MRSA CAP, 63,64 but has excellent negative predictive value for the exclusion of MRSA pneumonia in populations with low MRSA pneumonia incidence. 65 Given the rapid turnaround time of MRSA NP/OP PCR screening, it may be beneficial to perform NP/OP sampling on all CAP patients with MRSA risk factors.…”

Section: Microbiological Diagnosismentioning

confidence: 99%

Staphylococcus aureus Pneumonia in the Community

Wunderink

2020

Semin Respir Crit Care Med

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Abstract Staphylococcus aureus is an emergent etiology of community-acquired pneumonia (CAP) over the past 2 decades, with severe community-acquired pneumonia (SCAP) caused by methicillin-resistant S. aureus (MRSA) leading to critical illness and death. S. aureus colonization is associated with a high incidence of pneumonia. Panton-Valentine leukocidin (PVL) is one of the most important virulence factors of S. aureus associated with serious complications. In recent years, community-associated MRSA (CA-MRSA) clones that caused infections in young adults and healthy individuals with no exposure to health care settings and no classical risk factors have emerged. Clinical features at admission including concurrent influenza infection, hemoptysis, multilobar infiltrates, and neutropenia should suggest S. aureus CAP. Sputum Gram stains, cultures (or tracheobronchial aspirates or bronchoalveolar lavage in mechanically ventilated patients), polymerase chain reaction (nasopharyngeal or oropharyngeal or lower respiratory tract specimens), and two sets of blood cultures should be obtained from patients presenting with severe S. aureus CAP. For CAP due to methicillin-susceptible S. aureus, first-line therapy is usually cefazolin, oxacillin, or ceftaroline. For CA-MRSA pneumonia, linezolid is recommended. If vancomycin or teicoplanin are used, combination with clindamycin or rifampicin should be considered in cases of PVL-positive MRSA CAP.

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Systematic Review of the Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for MRSA Pneumonia

Cited by 31 publications

References 44 publications

Utility of methicillin‐resistant Staphylococcus aureus (MRSA) nasal screening in patients with acute myeloid leukemia (AML)

Utility of methicillin‐resistant Staphylococcus aureus (MRSA) nasal screening in patients with acute myeloid leukemia (AML)

Pharmacists' perceptions and practice changes resulting from emergence of the vancomycin‐piperacillin/tazobactam nephrotoxicity phenomenon

Staphylococcus aureus Pneumonia in the Community

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