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Comparison of Methicillin-Resistant Staphylococcus aureus Nasal Screening Predictive Value in the Intensive Care Unit
Mitchell S Buckley1, Emir Kobic1, Melanie Yerondopoulos1
1Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA.
Background:
The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening appears promising for antimicrobial stewardship programs. However, a paucity of data remains on the diagnostic performance of culture-based MRSA screen in the intensive care unit (ICU) for pneumonia and bacteremia.
Objective:
The objective of this study was to compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU and general ward patients.
Methods:
This multicenter, retrospective study was conducted over a 23-month period. Adult patients with MRSA nasal screening ≤48 hours of collecting a respiratory and/or blood culture with concurrent initiation of anti-MRSA therapy were included. The primary endpoint was to compare the negative predictive value (NPV) associated with culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia.
Results:
A total of 5106 patients representing the ICU (n = 2515) and general ward (n = 2591) were evaluated. The NPV of the MRSA nares for suspected pneumonia was not significantly different between ICU and general ward patient populations (98.3% and 97.6%, respectively; P = 0.41). The MRSA nares screening tool also had a high NPV for suspected bacteremia in ICU (99.8%) and general ward groups (99.7%) (P = 0.56). The overall positive MRSA nares rates in the ICU and general ward patient populations were 9.1% and 8.2%, respectively (P = 0.283). Moreover, MRSA-positive respiratory and blood cultures among ICU patients were 5.8% and 0.8%, respectively.
Conclusion And Relevance:
Our findings support the routine use of MRSA nasal screening using the culture-based method in ICU patients with pneumonia. Further research on the clinical performance for MRSA bacteremia in the ICU is warranted.
Insights
Culture-based methicillin-resistant Staphylococcus aureus (MRSA) nasal screening is effective for pneumonia in intensive care units (ICUs). This diagnostic tool shows high negative predictive value in both ICU and general ward patients for pneumonia and bacteremia.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Critical Care Medicine
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening is valuable for antimicrobial stewardship.
- Limited data exist on the diagnostic performance of MRSA nasal screening in intensive care units (ICUs) for pneumonia and bacteremia.
Purpose of the Study:
- To compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU versus general ward patients.
- To evaluate the negative predictive value (NPV) of MRSA nasal screening in ICU patients with suspected pneumonia.
Main Methods:
- A multicenter, retrospective study over 23 months included adult patients undergoing MRSA nasal screening within 48 hours of respiratory/blood culture and anti-MRSA therapy.
- The primary endpoint was comparing the NPV of culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia.
Main Results:
- The NPV for suspected pneumonia was high and not significantly different between ICU (98.3%) and general ward (97.6%) patients.
- The MRSA nasal screening tool demonstrated a high NPV for suspected bacteremia in both ICU (99.8%) and general ward (99.7%) patients.
- Overall MRSA nasal positivity rates were 9.1% in ICUs and 8.2% in general wards.
Conclusions:
- Findings support routine use of culture-based MRSA nasal screening for pneumonia in ICU patients.
- Further research is needed on the clinical performance of MRSA nasal screening for bacteremia in the ICU setting.
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