评估耐甲氧西林金黄色葡萄球菌聚合酶链反应鼻腔筛查作为抗菌药物管理工具。
Evaluating Methicillin-Resistant Staphylococcus aureus Polymerase Chain Reaction Nasal Screening as a Tool for Antimicrobial Stewardship.
机构信息
Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Pharmacy, University Hospital, Newark, New Jersey.
出版信息
J Surg Res. 2023 Mar;283:1047-1052. doi: 10.1016/j.jss.2022.11.054. Epub 2022 Dec 12.
INTRODUCTION
Initiation of broad-spectrum empiric antibiotics is common when infection is suspected in hospitalized adults. The benefits of early utilization of effective antibiotics are well documented. However, the negative effects of inappropriate antibiotic use have led to antimicrobial stewardship mandates. Recent data demonstrate the utility of methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal screening to steward anti-MRSA empiric antibiotics in pneumonia. We hypothesize that MRSA PCR nasal swabs would also be effective to rule out other MRSA infection to effectively limit unnecessary antibiotics for any infectious source.
METHODS
We performed a single-center retrospective chart review of all adult patient encounters from October 2019-July 2021 with MRSA PCR nasal testing. We then reviewed all charts to evaluate for the presence of infections based on source cultures results, as the gold standard. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated from 2 × 2 contingency tables.
RESULTS
Among all patients with MRSA nasal screening, 1189 patients had any infection. Prevalence of MRSA nasal carriage among patients screened was 12%. Prevalence of MRSA infection among all infections was 7.5%. MRSA nasal swabs demonstrated a negative predictive value of 100% for MRSA urinary tract infection, 97.9% for MRSA bacteremia, 97.8% for MRSA pneumonia, 92.1% for MRSA wound infection, and 96.6% for other MRSA infections. Overall, MRSA PCR nasal swabs had a sensitivity of 68.5%, specificity of 90.1%, positive predictive value of 23.7%, and negative predictive value of 98.5% for any infections.
CONCLUSIONS
MRSA PCR nasal swabs have a high negative predictive value for all infections. Our data support the use of MRSA PCR nasal swabs to rule out MRSA infection and thereby allow early de-escalation of MRSA coverage in hospitalized patients requiring empiric antibiotics. Implementation of MRSA screening could decrease antibiotic-associated morbidity, resistance, and costs. More studies should be conducted to validate these results and support these findings.
简介
当怀疑住院成人发生感染时，通常会开始使用广谱经验性抗生素。早期使用有效抗生素的益处已有充分的记录。然而，不适当使用抗生素的负面影响导致了抗菌药物管理的规定。最近的数据表明，耐甲氧西林金黄色葡萄球菌（MRSA）聚合酶链反应（PCR）鼻拭子筛查可用于管理肺炎中的抗 MRSA 经验性抗生素。我们假设，MRSA PCR 鼻拭子也可有效排除其他 MRSA 感染，从而有效限制任何感染源的不必要抗生素使用。
方法
我们对 2019 年 10 月至 2021 年 7 月期间所有接受过 MRSA PCR 鼻拭子检测的成年患者的病历进行了单中心回顾性图表审查。然后，我们根据源培养物结果（作为金标准）来评估所有病历是否存在感染。从 2×2 列联表中计算出敏感性、特异性、阴性预测值和阳性预测值。
结果
在所有接受 MRSA 鼻拭子筛查的患者中，有 1189 例患者存在任何感染。筛查患者中 MRSA 鼻携带率为 12%。所有感染中 MRSA 感染的发生率为 7.5%。MRSA 鼻拭子对 MRSA 尿路感染、MRSA 菌血症、MRSA 肺炎、MRSA 伤口感染和其他 MRSA 感染的阴性预测值分别为 100%、97.9%、97.8%、92.1%和 96.6%。总体而言，MRSA PCR 鼻拭子对所有感染的敏感性为 68.5%，特异性为 90.1%，阳性预测值为 23.7%，阴性预测值为 98.5%。
结论
MRSA PCR 鼻拭子对所有感染的阴性预测值均较高。我们的数据支持使用 MRSA PCR 鼻拭子来排除 MRSA 感染，从而允许对需要经验性抗生素的住院患者早期降低 MRSA 覆盖范围。实施 MRSA 筛查可以减少抗生素相关的发病率、耐药性和成本。应开展更多研究来验证这些结果并支持这些发现。
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