Impact of Nasal Swabs on Empiric Treatment of Respiratory Tract Infections (INSERT-RTI)

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Health Services Research

Background:

• Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings.
• Rapid diagnostic tools like MRSA polymerase-chain-reaction nasal swabs (PCRNS) offer high negative predictive value.
• Optimizing antibiotic stewardship is crucial for combating antimicrobial resistance.

Purpose of the Study:

• To evaluate the impact of a PCRNS education bundle on anti-MRSA therapy duration in respiratory tract infections (RTIs).
• To assess secondary outcomes including hospital length of stay, readmission rates, mortality, and cost.
• To determine if the intervention facilitated de-escalation of vancomycin therapy.

Main Methods:

• A pre- and post-intervention study design was employed.
• An education bundle on PCRNS utility was implemented for clinicians.
• Data on duration of anti-MRSA therapy, length of stay, mortality, readmission, and cost were collected and analyzed.

Main Results:

• Mean duration of anti-MRSA therapy decreased by 30.3 hours post-intervention (p=0.039).
• For patients with negative PCRNS results, therapy duration decreased by 39.7 hours (p=0.014).
• Median healthcare costs were significantly reduced post-intervention (p<0.01), with no adverse effects on length of stay, mortality, or readmission.

Conclusions:

• The PCRNS education bundle effectively reduced the duration of vancomycin therapy for MRSA.
• The intervention led to significant cost savings without compromising patient safety or clinical outcomes.
• This strategy represents a valuable approach to antibiotic stewardship in managing MRSA infections.