Evaluation of Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Prescribing Habits in Patients with a Positive MRSA Nasal Swab in the Absence of Positive Cultures
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Collection
2.3. Definitions
2.4. Statistical Analysis
3. Results
3.1. Inclusion and Exclusion
3.2. Baseline Characteristics
3.3. Duration of Anti-MRSA Therapy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Metlay, J.P.; Waterer, G.W.; Long, A.C.; Anzueto, A.; Brozek, J.; Crothers, K.; Whitney, C.G. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am. J. Respir. Crit. Care Med. 2019, 200, e45–e67. [Google Scholar] [CrossRef] [PubMed]
- Kalil, A.C.; Metersky, M.L.; Klompas, M.; Muscedere, J.; Sweeney, D.A.; Palmer, L.B.; Brozek, J.L. Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin. Infect. Dis. 2016, 63, e61–e111. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Robicsek, A.; Suseno, M.; Beaumont, J.L.; Thomson, R.B.; Peterson, L.R. Prediction of Methicillin-Resistant Staphylococcus aureus Involvement in Disease Sites by Concomitant Nasal Sampling. J. Clin. Microbiol. 2008, 46, 588–592. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Dangerfield, B.; Chung, A.; Webb, B.; Seville, M.T. Predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia. Antimicrob. Agents Chemother. 2014, 58, 859–864. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Giancola, S.E.; Nguyen, A.T.; Le, B.; Ahmed, O.; Higgins, C.; Sizemore, J.A.; Orwig, K.W. Clinical utility of a nasal swab methicillin-resistant Staphylococcus aureus polymerase chain reaction test in intensive and intermediate care unit patients with pneumonia. Diagn. Microbiol. Infect. Dis. 2016, 86, 307–310. [Google Scholar] [CrossRef]
- Smith, M.N.; Erdman, M.J.; Ferreira, J.A.; Aldridge, P.; Jankowski, C.A. Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia. J. Crit. Care. 2017, 38, 168–171. [Google Scholar] [CrossRef]
- Parente, D.M.; Cunha, C.B.; Mylonakis, E.; Timbrook, T.T. The Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening to Rule Out MRSA Pneumonia: A Diagnostic Meta-analysis with Antimicrobial Stewardship Implications. Clin. Infect. Dis. 2018, 67, 1–7. [Google Scholar] [CrossRef]
- Baby, N.; Faust, A.C.; Smith, T.; Sheperd, L.A.; Knoll, L.; Goodman, E.L. Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia. Antimicrob. Agents Chemother. 2017, 61, e02432-16. [Google Scholar] [CrossRef][Green Version]
- Dureau, A.F.; Duclos, G.; Antonini, F.; Boumaza, D.; Cassir, N.; Alingrin, J.; Leone, M. Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit. Eur. J. Clin. Microbiol. Infect. Dis. 2017, 36, 267–272. [Google Scholar] [CrossRef]
- Dunaway, S.; Orwig, K.W.; Arbogast, Z.Q.; Myers, Z.L.; Sizemore, J.A.; Giancola, S.E. Evaluation of a pharmacy-driven methicillin-resistant Staphylococcus aureus surveillance protocol in pneumonia. Int. J. Clin. Pharm. 2018, 40, 526–532. [Google Scholar] [CrossRef]
- Dadzie, P.; Dietrich, T.; Ashurst, J. 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. Cureus 2019, 11, e6378. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Woolever, N.L.; Schomberg, R.J.; Cai, S.; Dierkhising, R.A.; Dababneh, A.S.; Kujak, R.C. Pharmacist-Driven MRSA Nasal PCR Screening and the Duration of Empirical Vancomycin Therapy for Suspected MRSA Respiratory Tract Infections. Mayo Clin. Proc. Innov. Qual. Outcomes 2020, 4, 550–556. [Google Scholar] [CrossRef] [PubMed]
- Diep, C.; Meng, L.; Pourali, S.; Hitchcock, M.M.; Alegria, W.; Swayngim, R.; Holubar, M. Effect of rapid methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction screening on vancomycin use in the intensive care unit. Am. J. Health Syst. Pharm. 2021, 78, 2236–2244. [Google Scholar] [CrossRef] [PubMed]
- Pham, S.N.; Sturm, A.C.; Jacoby, J.S.; Egwuatu, N.E.; Dumkow, L.E. Impact of a Pharmacist-Driven MRSA Nasal PCR Protocol on Pneumonia Therapy. Hosp. Pharm. 2021, 56, 221–227. [Google Scholar] [CrossRef]
- Dadgostar, P. Antimicrobial Resistance: Implications and Costs. Infect. Drug. Resist. 2019, 12, 3903–3910. [Google Scholar] [CrossRef][Green Version]
- Shehab, N.; Patel, P.R.; Srinivasan, A.; Budnitz, D.S. Emergency department visits for antibiotic-associated adverse events. Clin. Infect. Dis. 2008, 47, 735–743. [Google Scholar] [CrossRef][Green Version]
- WHO Access, Watch, Reserve (AWaRe) Classification of Antibiotics for Evaluation and Monitoring of Use, 2021. Geneva: World Health Organization; 2021 (WHO/MHP/HPS/EML/2021.04). Licence: CC BY-NC-SA 3.0 IGO. Available online: https://www.who.int/publications/i/item/2021-aware-classification (accessed on 19 April 2023).
- Shariati, A.; Dadashi, M.; Moghadam, M.T.; Van Belkum, A.; Yaslianifard, S.; Darban-Sarokhalil, D. Global prevalence and distribution of vancomycin intermediate Staphylococcus aureus clinical isolates: A systematic review and meta-analysis. Sci. Rep. 2020, 10, 12689. [Google Scholar] [CrossRef]
- Jones, B.E.; Ying, J.; Stevens, V.; Haroldsen, C.; He, T.; Nevers, M.; Samore, M.H. Empirical Anti-MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for Pneumonia. JAMA Intern. Med. 2020, 180, 552. [Google Scholar] [CrossRef]
- Carey, G.B.; Holleck, J.L.; Ein Alshaeba, S.; Jayakrishnan, R.; Gordon, K.S.; Grimshaw, A.A.; Gunderson, C.G. Estimated mortality with early empirical antibiotic coverage of methicillin-resistant Staphylococcus aureus in hospitalized patients with bacterial infections: A systematic review and meta-analysis. J. Antimicrob. Chemother. 2023, 78, 1150–1159. [Google Scholar] [CrossRef]
- Acuna-Villaorduna, C.; Branch-Elliman, W.; Strymish, J.; Gupta, K. Active identification of patients who are methicillin-resistant Staphylococcus aureus colonized is not associated with longer duration of vancomycin therapy. Am. J. Infect. Control 2017, 45, 1081–1085. [Google Scholar] [CrossRef]
- De Jong, E.; De Jong, A.S.; Bartels, C.J.M.; Van Der Rijt-Van Den Biggelaar, C.; Melchers, W.J.G.; Sturm, P.D.J. Clinical and laboratory evaluation of a real-time PCR for Clostridium difficile toxin A and B genes. Eur. J. Clin. Microbiol. Infect. Dis. 2012, 31, 2219–2225. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Wright, W.F.; Overman, S.B.; Ribes, J.A. (1–3)-β-D-Glucan Assay: A Review of its Laboratory and Clinical Application. Lab. Med. 2011, 42, 679–685. [Google Scholar] [CrossRef]
Characteristics | All Patients (n = 52) |
---|---|
Age in years, median (IQR) | 61 (49.25–71.65) |
Race, n (%) | |
Caucasian | 33 (63.5) |
African American | 17 (32.7) |
Hispanic | 2 (3.8) |
Sex, n (%) | |
Male | 33 (63.5) |
Female | 19 (36.5) |
Hospital length of stay in days, median (IQR) | 10 (6–19) |
Treatment location, n (%) | |
Non-ICU | 26 (50) |
ICU | 26 (50) |
Indication for anti-MRSA therapy, n (%) | |
Respiratory infection | 37 (71.2) |
CAP | 28 (53.8) |
HAP | 8 (15.4) |
VAP | 1 (1.9) |
Non-respiratory infection | 15 (30.8) |
Sepsis | 4 (7.7) |
Bacteremia | 2 (3.8) |
Skin and soft tissue infection | 5 (9.6) |
Urinary tract infection | 3 (5.8) |
Osteomyelitis | 1 (1.9) |
Respiratory culture obtained, n (%) | 24 (46.2) |
Culture specimen, n (%) | |
Sputum | 5 (20.8) |
Bronchoalveolar lavage (BAL) | 17 (70.8) |
Tracheal aspirate | 2 (8.3) |
Group | Total Duration of Anti-MRSA Therapy in Days, Median (IQR) | Duration of Anti-MRSA Therapy Following MRSA PCR Result in Days, Median (IQR) |
---|---|---|
All patients (n = 52) | 5 (3–6) | 4 (3–5.25) |
Treatment location | ||
Non-ICU (n = 26) | 4 (3–6.25) | 4 (2.75–6) |
ICU (n = 26) | 5 (3–5.25) | 4 (3–5) |
Type of pneumonia | ||
CAP (n = 19) | 4 (2.25–5) | 4 (2.25–5) |
HAP (n = 7) | 7 (5.25–7) | 6 (4.25–10.75) |
VAP (n = 1) | 3 (n/a) | 3 (n/a) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Pelham, M.; Ganter, M.; Eudy, J.; Anderson, D.T. Evaluation of Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Prescribing Habits in Patients with a Positive MRSA Nasal Swab in the Absence of Positive Cultures. Pharmacy 2023, 11, 81. https://doi.org/10.3390/pharmacy11030081
Pelham M, Ganter M, Eudy J, Anderson DT. Evaluation of Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Prescribing Habits in Patients with a Positive MRSA Nasal Swab in the Absence of Positive Cultures. Pharmacy. 2023; 11(3):81. https://doi.org/10.3390/pharmacy11030081
Chicago/Turabian StylePelham, Madeline, Madeline Ganter, Joshua Eudy, and Daniel T. Anderson. 2023. "Evaluation of Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Prescribing Habits in Patients with a Positive MRSA Nasal Swab in the Absence of Positive Cultures" Pharmacy 11, no. 3: 81. https://doi.org/10.3390/pharmacy11030081
APA StylePelham, M., Ganter, M., Eudy, J., & Anderson, D. T. (2023). Evaluation of Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Prescribing Habits in Patients with a Positive MRSA Nasal Swab in the Absence of Positive Cultures. Pharmacy, 11(3), 81. https://doi.org/10.3390/pharmacy11030081