Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening in Hospitalized Children with Acute Infectious Disease Syndromes.

Ashley Sands,Nicole Mulvey,Denise Iacono,Jane Cerise,Stefan H F Hagmann

doi:10.3390/antibiotics10121434

Abstract

Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients admitted between 1 January 2015 and 31 December 2020 with a presumed infectious diagnosis who were started on anti-MRSA antibiotics, had a PCR-based MNS, and a clinical culture performed were retrospectively reviewed. A total of 95 children were included with a median age (range) of 2 (0–17) years. The top three diagnosis groups were skin and soft tissue infections (n = 38, 40%), toxin-mediated syndromes (n = 17, 17.9%), and osteoarticular infections (n = 14, 14.7%). Nasal MRSA colonization and growth of MRSA in clinical cultures was found in seven patients (7.4%) each. The specificity and the negative predictive value (NPV) of the MNS to predict a clinical MRSA infection were both 95.5%. About half (n = 55, 57.9%) had anti-MRSA antibiotics discontinued in-house. A quarter (n = 14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n = 21, 38.2%) after negative MNS test and negative culture results became available. A high NPV suggests that MNS may be useful for limiting unnecessary anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies are needed to further characterize the utility of MNS for specific infectious diagnoses.

Highlights

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of both localized and invasive suppurative infections as well as several toxin-mediated syndromes in children
In our study of pediatric patients hospitalized for a presumed infectious diagnosis and started on empiric broad-spectrum antimicrobial treatment including anti-MRSA antibiotics, an MRSA nares screening (MNS) test, when correlated with clinical cultures, was found to have a high negative predictive value (NPV) for a clinical MRSA infection
Similar to previous analyses in adults that are promoting MNS as a potentially powerful stewardship tool for de-escalation and avoidance of empirical anti-MRSA therapy [3,4,5,6,7], our findings suggest that MNS could be a useful tool in limiting anti-MRSA antimicrobials in pediatric patients

Summary

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of both localized and invasive suppurative infections as well as several toxin-mediated syndromes in children. This has led to the frequent inclusion of anti-MRSA antimicrobials in empiric management plans for pediatric patients treated for presumed infections. Multiple clinical studies in adult patients, especially with pneumonia, have demonstrated the usefulness of a negative MRSA nares screening (MNS) test in aiding the de-escalation of anti-MRSA antimicrobials [3,4,5,6]. It has been demonstrated that MNS is a valuable antimicrobial stewardship tool with potential applications beyond lower respiratory tract infections, including patients with bloodstream, abdominal, and skin and soft tissue infections [7]

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