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Change in Methicillin-Resistant Staphylococcus aureus Testing in the Intensive Care Unit as an Antimicrobial
Hayden L Smith1, Samuel P DuMontier1, Amanda M Bushman2
1Medical Education Services, UnityPoint Health-Des Moines, Des Moines, IA.
Abstract:
Background: Methicillin-resistant Staphylococcus aureus (MRSA)-associated infections are a cause of morbidity and mortality in the intensive care unit (ICU). Vancomycin is a treatment option but is not without risks. Methods: A MRSA testing change-the switch from culture to polymerase chain reaction-was implemented at 2 adult (tertiary and community) ICUs located in a Midwestern US health system. Data from 2016 to 2020 were included in the study, and the median change in time to test results was examined. Results: During the study period, 71% of 19,975 patients seen at the 2 ICUs received MRSA testing. In the preintervention period, 91% and 99% of patients at the tertiary and community hospitals received testing via culture, respectively. Culture testing was used 1% and ∼0% of the time at the tertiary and community hospitals, respectively, in the postintervention period. A counterfactual estimate showed 36 (95% credible interval [CrI], 35, 37) and 32 (95% CrI, 31, 33) fewer hours until results were available at the tertiary and community hospitals, respectively. Conclusion: After the testing change, MRSA results were available in less time. Obtaining results sooner can assist with antimicrobial stewardship through the potential delay in initiating therapies such as vancomycin and/or quicker de-escalation of such therapies.
Insights
Switching to polymerase chain reaction (PCR) for methicillin-resistant Staphylococcus aureus (MRSA) testing in ICUs significantly reduced turnaround time for results. Faster MRSA test results aid antimicrobial stewardship by optimizing vancomycin use.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Healthcare Quality Improvement
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) infections pose significant morbidity and mortality risks in intensive care units (ICUs).
- Vancomycin is a primary treatment for MRSA but carries inherent risks and requires careful management.
Purpose of the Study:
- To evaluate the impact of switching MRSA diagnostic methodology from culture to PCR on time to results in adult ICUs.
- To assess the effect of accelerated MRSA test results on antimicrobial stewardship practices.
Main Methods:
- A change in MRSA testing strategy from culture to PCR was implemented across two ICUs (tertiary and community) within a Midwestern US health system.
- Data from 2016-2020 were analyzed, focusing on the median change in time to obtain MRSA test results before and after the intervention.
Main Results:
- MRSA testing was performed on 71% of 19,975 ICU patients during the study period.
- The implementation of PCR testing led to a significant reduction in time to results, with estimated savings of 36 and 32 hours at the tertiary and community hospitals, respectively.
- Culture-based testing decreased dramatically post-intervention, becoming nearly obsolete.
Conclusions:
- The transition to PCR-based MRSA testing substantially decreased the time required to obtain results in ICUs.
- Expedited MRSA test results support antimicrobial stewardship by enabling timely initiation or de-escalation of therapies like vancomycin.
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