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The Clinical Value of Methicillin-Resistant Staphylococcus aureus Nasal Screening in the Management of Diabetic Foot
Jeff Hosry1, Taylor Wang1, Marc Assaad1
1Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA.
Abstract:
Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) remains an important risk factor for diabetic foot infections (DFIs). We explored herein the clinical value of MRSA-nasal screening in the management of DFIs. In this retrospective case-control study, patients admitted with a DFI between 1/1/2014-6/30/2020 were studied and divided into cases (positive MRSA-nasal screening) and controls (negative MRSA-nasal). We included 171 patients (22 cases and 149 controls). MRSA nasal screening had a negative predictive value (NPV) of 86%. Compared to controls, cases were treated with intravenous vancomycin for a longer duration: (median [IQR], 5[3,11] vs 2[2,6]) days, P = .037). In multivariate analysis, a negative MRSA nasal screening was associated with a 74% decreased risk of AKI (OR = 0.26, 95% CI = 0.07-0.89). MRSA nasal screening in patients admitted with DFI has a high NPV. Obtained early, it can shorten the duration of intravenous vancomycin, consequently preventing AKI.
Insights
Screening for methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in diabetic foot infection patients is valuable. A negative MRSA nasal screen can reduce vancomycin use and prevent acute kidney injury (AKI).
Area of Science:
- Infectious Diseases
- Nephrology
- Diabetology
Background:
- Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is a significant risk factor for diabetic foot infections (DFIs).
- Effective management of DFIs requires understanding and mitigating risks associated with MRSA colonization.
Purpose of the Study:
- To evaluate the clinical utility of MRSA nasal screening in the management of patients admitted with DFIs.
- To determine the association between MRSA nasal carriage and clinical outcomes, including treatment duration and acute kidney injury (AKI).
Main Methods:
- Retrospective case-control study of 171 patients admitted with DFIs between January 2014 and June 2020.
- Patients were categorized into cases (MRSA nasal screen positive) and controls (MRSA nasal screen negative).
- Analysis included negative predictive value (NPV) calculation and multivariate analysis for AKI risk.
Main Results:
- MRSA nasal screening demonstrated a high negative predictive value (NPV) of 86%.
- Patients with positive MRSA nasal screening received longer durations of intravenous vancomycin compared to controls (median [IQR], 5[3,11] vs 2[2,6] days, P=.037).
- A negative MRSA nasal screen was significantly associated with a 74% decreased risk of AKI (OR=0.26, 95% CI=0.07-0.89).
Conclusions:
- MRSA nasal screening in patients with DFIs has a high NPV, aiding in risk stratification.
- Early MRSA nasal screening can guide treatment decisions, potentially shortening vancomycin therapy duration.
- Implementing MRSA nasal screening may contribute to the prevention of AKI in DFI patients.
