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Pharmacist-Driven Methicillin-Resistant S. aureus Polymerase Chain Reaction Testing for Pneumonia
Victoria Marinucci1, Patricia R Louzon2, Amy L Carr2
1AdventHealth Altamonte Springs, Altamonte Springs, FL, USA.
Background:
Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) can be detected using nasal swab polymerase chain reaction (PCR) assay and is associated with clinical MRSA infection. The MRSA nasal PCR has a rapid turnaround time and a negative predictive value for MRSA pneumonia of >98%; however, data are limited in critically ill patients.
Objective:
The purpose of this study is to determine the impact of a pharmacist-driven algorithm, utilizing MRSA PCR nasal screening on duration of anti-MRSA therapy in patients admitted to the intensive care unit (ICU) with suspected pneumonia.
Methods:
A single-center pre/post study was conducted in 4 ICUs at a large tertiary care community hospital. Adult patients admitted to the ICU initiated on vancomycin or linezolid for pneumonia managed using a pharmacist-driven MRSA PCR algorithm were included in the algorithm cohort. A historical cohort with standard management was matched 1:1 by age, type of pneumonia, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was duration of anti-MRSA therapy. Secondary outcomes included MRSA rates, number of vancomycin levels, new onset of acute kidney injury (AKI), ICU length of stay (LOS), hospital LOS, and mortality.
Results:
Of the 245 patients screened, 50 patients met inclusion criteria for the algorithm cohort and were matched to 50 patients in the historical cohort. The duration of anti-MRSA therapy was significantly lower compared with the historical cohort (47 vs 95 hours; P < 0.001). Secondary outcomes were similar between groups for MRSA rates, new onset of AKI, LOS, and mortality. There were less vancomycin levels ordered in the algorithm cohort (2 vs 3, P = 0.026).
Conclusions:
A pharmacist-driven MRSA PCR algorithm significantly reduced anti-MRSA duration of therapy in critically ill patients with pneumonia. Future studies should validate these results in critically ill populations and in settings where MRSA pneumonia is more prevalent.
Insights
A pharmacist-driven methicillin-resistant Staphylococcus aureus (MRSA) PCR algorithm reduced the duration of anti-MRSA therapy in critically ill patients with pneumonia. This approach offers a promising strategy for optimizing antibiotic use in intensive care units (ICUs).
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Critical Care Medicine
Background:
- Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for infection.
- Nasal swab PCR assays rapidly detect MRSA colonization with high negative predictive value for pneumonia.
- Data on MRSA PCR utility in critically ill patients are limited.
Purpose of the Study:
- To evaluate the impact of a pharmacist-driven algorithm using MRSA PCR nasal screening.
- To determine the effect on the duration of anti-MRSA therapy in intensive care unit (ICU) patients with suspected pneumonia.
Main Methods:
- A single-center pre/post study design in four ICUs.
- Inclusion of adult ICU patients initiated on vancomycin or linezolid for pneumonia.
- Matching of an algorithm cohort with a historical cohort based on age, pneumonia type, and APACHE II score.
Main Results:
- The algorithm cohort had significantly shorter anti-MRSA therapy duration (47 vs. 95 hours; P < 0.001).
- Fewer vancomycin levels were ordered in the algorithm group (2 vs. 3; P = 0.026).
- MRSA rates, AKI, LOS, and mortality were similar between groups.
Conclusions:
- A pharmacist-driven MRSA PCR algorithm effectively reduced anti-MRSA therapy duration in critically ill pneumonia patients.
- This strategy can optimize antibiotic use in the ICU setting.
- Further validation in diverse critically ill populations and high MRSA prevalence settings is warranted.
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