Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) polymerase-chain-reaction nasal swabs (PCRNS) are a rapid diagnostic tool with a high negative predictive value. A PCRNS plus education “bundle” was implemented to inform clinicians on the utility of PCRNS for anti-MRSA therapy de-escalation in respiratory tract infections (RTI). The study included patients started on vancomycin with a PCRNS order three months before and after bundle implementation. The primary objective was the difference in duration of anti-MRSA therapy (DOT) for RTI. Secondary objectives included hospital length of stay (LOS), anti-MRSA therapy reinitiation, 30-day readmission, in-hospital mortality, and cost. We analyzed 62 of 110 patients screened, 20 in the preintervention and 42 in the postintervention arms. Mean DOT decreased after bundle implementation by 30.3 h (p = 0.039); mean DOT for patients with a negative PCRNS decreased by 39.7 h (p = 0.014). Median cost was lower after intervention [USD$51.69 versus USD$75.30 (p < 0.01)]. No significant difference in LOS, mortality, or readmission existed. The bundle implementation decreased vancomycin therapy and cost without negatively impacting patient outcomes.
Highlights
The Center for Disease Control and Prevention recognizes Methicillin-resistantStaphylococcus aureus (MRSA) as a “serious threat” within the community and hospital settings [1].Methicillin-resistant Staphylococcus aureus (MRSA), a common etiology of pneumonia, is responsible for high rates of morbidity, mortality, antimicrobial resistance, and healthcare costs, hospitals may be overusing anti-MRSA therapies based on documented MRSA infection rates [2,3,4]
Current guidelines for the treatment of MRSA respiratory tract infections (RTI) recommend rapid initiation of adequate antibiotic therapy with vancomycin or linezolid. These two antibiotics constitute the treatment of choice for MRSA bacterial infections, but antimicrobial resistance has been steadily on the rise, demanding new strategies to preserve the utility of these agents for the future [5,6,7]
This is a quasi-experimental study comparing the duration of anti-MRSA therapy in patients diagnosed with RTI before and after the implementation of an educational program on the usage of MRSA polymerase-chain-reaction nasal swabs (PCRNS) for de-escalation of anti-MRSA therapy
Summary
The Center for Disease Control and Prevention recognizes Methicillin-resistantStaphylococcus aureus (MRSA) as a “serious threat” within the community and hospital settings [1].MRSA, a common etiology of pneumonia, is responsible for high rates of morbidity, mortality, antimicrobial resistance, and healthcare costs, hospitals may be overusing anti-MRSA therapies based on documented MRSA infection rates [2,3,4]. Current guidelines for the treatment of MRSA respiratory tract infections (RTI) recommend rapid initiation of adequate antibiotic therapy with vancomycin or linezolid. These two antibiotics constitute the treatment of choice for MRSA bacterial infections, but antimicrobial resistance has been steadily on the rise, demanding new strategies to preserve the utility of these agents for the future [5,6,7]. In suspected RTI, common culture-identifying tests, including sputum cultures and bronchi-alveolar lavage (BAL), are recommended to guide therapy These methods could be inconclusive due to insufficient or contaminated samples, respiratory tract bacterial colonization, or sample collection after antibiotic administration [6]. The procedure is invasive and not always feasible to conduct [9]
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