Abstract
Introduction
Initiation of broad-spectrum empiric antibiotics is common when infection is suspected
in hospitalized adults. The benefits of early utilization of effective antibiotics
are well documented. However, the negative effects of inappropriate antibiotic use
have led to antimicrobial stewardship mandates. Recent data demonstrate the utility
of methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal screening to steward anti-MRSA empiric
antibiotics in pneumonia. We hypothesize that MRSA PCR nasal swabs would also be effective
to rule out other MRSA infection to effectively limit unnecessary antibiotics for
any infectious source.
Methods
We performed a single-center retrospective chart review of all adult patient encounters
from October 2019-July 2021 with MRSA PCR nasal testing. We then reviewed all charts
to evaluate for the presence of infections based on source cultures results, as the
gold standard. Sensitivity, specificity, negative predictive value, and positive predictive
value were calculated from 2 × 2 contingency tables.
Results
Among all patients with MRSA nasal screening, 1189 patients had any infection. Prevalence
of MRSA nasal carriage among patients screened was 12%. Prevalence of MRSA infection
among all infections was 7.5%. MRSA nasal swabs demonstrated a negative predictive
value of 100% for MRSA urinary tract infection, 97.9% for MRSA bacteremia, 97.8% for
MRSA pneumonia, 92.1% for MRSA wound infection, and 96.6% for other MRSA infections.
Overall, MRSA PCR nasal swabs had a sensitivity of 68.5%, specificity of 90.1%, positive
predictive value of 23.7%, and negative predictive value of 98.5% for any infections.
Conclusions
MRSA PCR nasal swabs have a high negative predictive value for all infections. Our
data support the use of MRSA PCR nasal swabs to rule out MRSA infection and thereby
allow early de-escalation of MRSA coverage in hospitalized patients requiring empiric
antibiotics. Implementation of MRSA screening could decrease antibiotic-associated
morbidity, resistance, and costs. More studies should be conducted to validate these
results and support these findings.
Keywords
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Article info
Publication history
Published online: December 12, 2022
Accepted:
November 20,
2022
Received in revised form:
November 14,
2022
Received:
March 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
