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Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes
Hayley B Gershengorn1,2, Hannah Wunsch3,4,5, Bhavarth Shukla6
1Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Objective:
To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics.
Design:
Retrospective cohort study.
Setting:
PINC-A1 Healthcare Database (2008-2021).
Participants:
Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.
Methods:
We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital.
Results:
We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0-37.6%; full range: 0%-98.0%]; median odds ratio [95% CI]: 84.7 [63.3-115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%-0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04-1.31], P = .007).
Conclusions:
Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration.
Insights
Early use of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs varied significantly across US hospitals, increasing over time. Hospitals with higher swab use were linked to shorter durations of MRSA-specific antibiotic treatment.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Health Services Research
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant healthcare challenge.
- Early detection of MRSA colonization through nasal swabs can inform treatment strategies.
- Antibiotic stewardship programs aim to optimize antimicrobial use and reduce resistance.
Purpose of the Study:
- To examine the trends and interhospital variations in the early use of MRSA nasal swabs in US hospitals.
- To investigate the association between early MRSA nasal swab use and the de-escalation of MRSA-specific antibiotics in patients with sepsis and mechanical ventilation.
Main Methods:
- Retrospective cohort study utilizing the PINC-A1 Healthcare Database (2008-2021).
- Included adult patients with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.
- Assessed trends and variations in early (by hospital day 2) polymerase chain reaction-based MRSA nasal swab use.
- Used competing risks multivariable regression to analyze the association between swab use intensity and anti-MRSA antibiotic duration.
Main Results:
- A total of 699,474 patients from 788 hospitals were analyzed for swab use trends.
- Early MRSA nasal swab use increased from 3.5% in 2008 to 29.5% in 2021.
- Significant interhospital variation in swab use was observed (median 6.0%, range 0%-98.0%).
- Patients in hospitals with high swab use (≥90%) had shorter durations of anti-MRSA antibiotics compared to those in low-use hospitals (<10%) (aSHR: 1.17, P = .007).
Conclusions:
- Early polymerase chain reaction-based MRSA nasal swab use is increasingly adopted but shows substantial variation across US hospitals.
- Higher rates of early MRSA nasal swab utilization are associated with reduced durations of anti-MRSA antibiotic therapy.
- These findings suggest that early MRSA nasal swab use may facilitate antibiotic de-escalation strategies.
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