Highlights
- •There is increasing evidence that methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs have a high negative predictive value in skin and skin structure infections (SSSIs).
- •Negative MRSA nasal swabs have potential to decrease duration of vancomycin and other anti-MRSA therapy in SSSIs.
- •Implementation of MRSA nasal swabs and their utility in potential de-escalation may contribute to antimicrobial stewardship goals.
Abstract
Background
Negative methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs have a high negative predictive value of approximately 99% in
respiratory infections. There is, however, a lack of data evaluating its use beyond
respiratory infections.
Methods
We conducted a retrospective analysis to determine the clinical utility of MRSA swabs
for identifying MRSA-associated skin and skin structure infections (SSSIs) and the
potential effects on antimicrobial stewardship efforts. Baseline characteristics,
culture data, and antibiotic data were collected to determine the difference in duration
of vancomycin therapy. Positive predictive value, negative predictive value, sensitivity,
and specificity were secondary outcomes.
Results
A total of 473 patients were included, of which 156 patients had a positive MRSA nasal
swab and 317 patients had a negative swab. The median duration of vancomycin was 4
days in the positive group and 3 days in the negative group (P = .01). The positive predictive value and negative predictive value were 22.4% and
97.5%. The sensitivity and specificity were 81.4% and 71.9%.
Conclusion
Patients with a negative MRSA nasal swab received approximately 1 day less of vancomycin,
which represented a decrease in drug administered. The negative predictive value for
SSSIs is promising, showing potential for the role of MRSA nasal swabs in de-escalating
therapy.
Key Words
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Article Info
Publication History
Published online: December 24, 2021
Footnotes
Conflicts of interest: Krutika N. Mediwala has speakers bureau with Cepheid Diagnostics. The remaining authors have nothing to report.
Identification
Copyright
© 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
