Prospective Nasal Screening for Methicillin-Resistant Staphylococcus aureus in Critically Ill Patients With Suspected Pneumonia

Nicholas Raush, Kevin D Betthauser, Karen Shen, Tamara Krekel, Marin H Kollef, Nicholas Raush, Kevin D Betthauser, Karen Shen, Tamara Krekel, Marin H Kollef

Abstract

We carried out a prospective de-escalation study based on methicillin-resistant Staphylococcus aureus (MRSA) nasal cultures in intensive care unit patients with suspected pneumonia. Days of anti-MRSA therapy was significantly reduced in the intervention group (2 [0-3] days vs 1 [0-2] day; P < .01). Time to MRSA de-escalation was also shortened in the intervention group.

Keywords: Staphylococcus aureus; intensive care; pneumonia; screening.

© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

References

    1. Sarikonda KV, Micek ST, Doherty JA, et al. . Methicillin-resistant Staphylococcus aureus nasal colonization is a poor predictor of intensive care unit-acquired methicillin-resistant Staphylococcus aureus infections requiring antibiotic treatment. Crit Care Med 2010; 38:1991–5.
    1. Langsjoen J, Brady C, Obenauf E, Kellie S.. Nasal screening is useful in excluding methicillin-resistant Staphylococcus aureus in ventilator-associated pneumonia. Am J Infect Control 2014; 42:1014–5.
    1. Chotiprasitsakul D, Tamma PD, Gadala A, Cosgrove SE.. The role of negative methicillin-resistant Staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients. Infect Control Hosp Epidemiol 2018; 39:290–6.
    1. Dangerfield B, Chung A, Webb B, Seville MT.. Predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia. Antimicrob Agents Chemother 2014; 58:859–64.
    1. Rocha LA, Marques Ribas R, da Costa Darini AL, Gontijo Filho PP.. Relationship between nasal colonization and ventilator-associated pneumonia and the role of the environment in transmission of Staphylococcus aureus in intensive care units. Am J Infect Control 2013; 41:1236–40.
    1. Willis C, Allen B, Tucker C, et al. . Impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus surveillance protocol. Am J Health Syst Pharm 2017; 74:1765–73.
    1. Smith MN, Erdman MJ, Ferreira JA, et al. . Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia. J Crit Care 2017; 38:168–71.
    1. Smith MN, Brotherton AL, Lusardi K, et al. . Systematic review of the clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening for MRSA pneumonia. Ann Pharmacother 2019; 53:627–38.
    1. Trupka T, Fisher K, Micek ST, et al. . Enhanced antimicrobial de-escalation for pneumonia in mechanically ventilated patients: a cross-over study. Crit Care 2017; 21:180.
    1. Micek ST, Ward S, Fraser VJ, Kollef MH.. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004; 125:1791–9.
    1. Kalil AC, Metersky ML, Klompas M, et al. . Executive summary: 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; 63:575–82.

Source: PubMed

3
Suscribir