Change in Methicillin-Resistant Staphylococcus aureus Testing in the Intensive Care Unit as an Antimicrobial Stewardship Initiative.

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.