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Emergency department methicillin-resistant Staphylococcus aureus nare screen effect on pneumonia treatment duration
Anthony J Renzoni1, Gary D Peksa2, Joshua M DeMott2
1Department of Pharmacy, Rush University Medical Center, Chicago, IL, United States of America.
Study Objective:
The objective of this study was to determine if performing a methicillin-resistant Staphylococcus aureus (MRSA) nasal screen in the emergency department (ED) decreased general medicine patient exposure to anti-MRSA antibiotics for pneumonia.
Methods:
This was a single-center, retrospective study evaluating patients who had a diagnosis of pneumonia and were initiated on anti-MRSA therapy (vancomycin or linezolid) in the ED and subsequently admitted to a general medicine floor. Patients were divided into two groups: 1) did not receive a MRSA nares screen in the ED (No MRSA screen group) or 2) received a MRSA nares screen in the ED (MRSA screen group). The primary outcome was anti-MRSA antibiotic duration. Secondary outcomes included vancomycin level evaluation, hospital survival, and acute kidney injury.
Results:
Of the 116 patients included, 37 patients received a MRSA nares screen in the ED and 79 patients did not. Median duration of antibiotic exposure was similar for both groups (No MRSA screen, 30.5 h [interquartile range (IQR) 20.5-52.5] vs. MRSA screen, 24.5 h [IQR 20.6-40.3]; p = 0.28). Of patients who were screened, 35 were negative and 2 were positive. Secondary outcomes were similar.
Conclusion:
Performing a MRSA nares screen in the ED for patients diagnosed with pneumonia, initiated on anti-MRSA antibiotics, and admitted to a general medicine floor did not decrease duration of anti-MRSA antibiotics. At this time, ED providers do not need to consider a MRSA nasal screen in the ED for patients being admitted to general medicine, although larger studies could be considered.
Insights
Performing a methicillin-resistant Staphylococcus aureus (MRSA) nasal screen in the emergency department did not reduce the duration of anti-MRSA antibiotic use for pneumonia patients admitted to general medicine. Further research is not recommended at this time.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Hospital Medicine
Background:
- Pneumonia treatment often involves antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA).
- The utility of routine MRSA nasal screening in the Emergency Department (ED) for patients admitted to general medicine is not well-established.
- Reducing unnecessary antibiotic exposure is a key goal in antimicrobial stewardship.
Purpose of the Study:
- To evaluate if MRSA nasal screening in the ED impacts the duration of anti-MRSA antibiotic therapy for pneumonia patients.
- To assess the effect of ED MRSA screening on antibiotic exposure in general medicine admissions.
Main Methods:
- A single-center, retrospective study compared patients with pneumonia initiated on anti-MRSA therapy in the ED.
- Patients were categorized into two groups: those who received an ED MRSA nares screen and those who did not.
- Primary outcome was the duration of anti-MRSA antibiotic exposure; secondary outcomes included vancomycin levels, survival, and acute kidney injury.
Main Results:
- No significant difference in median anti-MRSA antibiotic duration was observed between the MRSA screen group (24.5 hours) and the no MRSA screen group (30.5 hours).
- Of the 37 screened patients, only 2 tested positive for MRSA.
- Secondary outcomes were similar between the two groups.
Conclusions:
- ED MRSA nasal screening did not decrease the duration of anti-MRSA antibiotic use for pneumonia patients admitted to general medicine.
- Current evidence does not support routine ED MRSA nasal screening for this patient population.
- Larger studies may be considered to further investigate this practice.
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