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Impact of Methicillin-Resistant Staphylococcus aureus Nasal PCR Versus Culture on Vancomycin Utilization in Pneumonia
Surafel G Mulugeta1, Shivani Kantharia1, Michael P Veve1,2
1Department of Pharmacy, Henry Ford Health System, Detroit, MI, USA.
Abstract:
Introduction: Methicillin-resistant Staphylococcus aureus pneumonia (PNA) can be ruled out via methicillin-resistant Staphylococcus aureus (MRSA) culture and polymerase chain reaction (PCR) nasal screening, facilitating the de-escalation of empiric anti-MRSA agents like intravenous vancomycin. This study evaluated the impact of transitioning from culture to PCR-based MRSA nasal screening in patients with PNA. Methods: This Institutional Review Board (IRB)-approved retrospective quasi-experimental study was conducted at a 5-hospital system and included adult, nonpregnant hospitalized patients from September to December 2021 ("culture group") and September to December 2022 ("PCR group") and diagnosed with PNA. Exclusion criteria were ventilator-acquired PNA or positive MRSA respiratory culture. The primary endpoint was the number of vancomycin levels obtained. Secondary endpoints were vancomycin duration as well as acute kidney injury (AKI) and all-cause 30-day readmission rates. Results: Two-hundred patients were included: 100 in each group. Baseline characteristics were similar. There were 117 vancomycin levels obtained: 67 (67) and 50 (50) in the culture and PCR group, respectively (P = .021). Median vancomycin duration was 50% shorter in the PCR group: 2 days (1-3) versus 3 days (2-4), P < .001. After adjusting for confounders, the culture group was more likely to have vancomycin levels obtained compared to the PCR group: adjusted odd ratio (aOR) (95% confidence interval [CI])] = 1.833 (1.016-3.309). Long-term obstructive pulmonary disease was associated with reduced risk of ordering vancomycin levels: aOR [95% CI] = 0.426 (0.218-0.831). Readmission and AKI rates were comparable. Conclusion: Transitioning from culture to PCR-based MRSA nasal screening significantly reduced vancomycin levels obtained from patients and shortened vancomycin duration without negatively impacting patient outcome.
Insights
Switching to PCR-based MRSA nasal screening for pneumonia patients reduced vancomycin use and monitoring. This change shortened treatment duration without affecting patient outcomes like AKI or readmissions.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia necessitates targeted antimicrobial therapy, often involving vancomycin.
- Rapid and accurate MRSA detection is crucial for timely de-escalation of empiric antibiotics.
- Current diagnostic strategies include culture and polymerase chain reaction (PCR) for MRSA nasal screening.
Purpose of the Study:
- To evaluate the clinical and economic impact of transitioning from MRSA culture to PCR-based nasal screening in patients with pneumonia.
- To assess changes in vancomycin utilization, duration, and associated patient outcomes.
Main Methods:
- A retrospective quasi-experimental study comparing two groups of hospitalized adult patients with pneumonia.
- The 'culture group' (n=100) used MRSA culture screening (Sept-Dec 2021), while the 'PCR group' (n=100) used MRSA PCR screening (Sept-Dec 2022).
- Primary endpoint: vancomycin levels obtained. Secondary endpoints: vancomycin duration, acute kidney injury (AKI), and 30-day readmission rates.
Main Results:
- The PCR group had significantly fewer vancomycin levels obtained (50 vs. 67) and a 50% shorter median vancomycin duration (2 days vs. 3 days).
- Adjusted analysis showed the culture group was more likely to have vancomycin levels ordered (aOR 1.833).
- Acute kidney injury and 30-day readmission rates were comparable between the groups.
Conclusions:
- Transitioning to PCR-based MRSA nasal screening effectively reduced vancomycin monitoring and treatment duration in pneumonia patients.
- This diagnostic shift improved antimicrobial stewardship without compromising patient safety or clinical outcomes.
- PCR-based screening offers a more efficient approach for managing MRSA in pneumonia.
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