Clinical Utility of Methicillin‐Resistant Staphylococcus aureus Nasal Screening for Antimicrobial Stewardship: A Review of Current Literature

Abstract

Significant clinical and financial consequences are associated with both inadequate and unnecessary exposure to broad‐spectrum antibiotics. As such, antimicrobial stewardship programs seek objective, reliable, and cost‐effective tests to identify patients at highest or lowest risk for drug‐resistant organisms to guide empirical antimicrobial selection. Use of methicillin‐resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA in lower respiratory tract infections has led to significant reductions in duration of vancomycin therapy. The clinical utility of MRSA nasal screening in other types of infection remains less clear. This review describes the performance of MRSA nasal screening in predicting MRSA infection, highlights practical considerations for use of MRSA nasal screening, and provides guidance for incorporating MRSA nasal screening into clinical practice. With a high negative predictive value when the prevalence of MRSA is low, MRSA nasal screening is a valuable antimicrobial stewardship tool with potential applications beyond lower respiratory tract infections. In appropriately selected patients, negative MRSA nasal screening can prevent initiation or guide discontinuation of anti‐MRSA therapy. Antimicrobial stewardship programs should develop institutional guidelines to promote proper use of MRSA nasal screening. Pharmacists are well positioned to assist with education, interpretation, and application of MRSA nasal screening results.

Systematic Review of the Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for MRSA Pneumonia

“…A recent review describing MRSA nasal screening for ASP use across all infections recommends using this test for pulmonary infections but cautious use in BSIs because of the high risk of mortality with inappropriate antibiotic selection. 45 Additional sites that may be considered, despite a paucity of evidence, include intra-abdominal, skin and soft tissue, and urinary tract infections. 45…”

“…45 Additional sites that may be considered, despite a paucity of evidence, include intra-abdominal, skin and soft tissue, and urinary tract infections. 45…”

Diagnostic accuracy of Gram staining when predicting staphylococcal hospital-acquired pneumonia and ventilator-associated pneumonia: a systematic review and meta-analysis

“…This rationale has been applied to MRSA nasal colonization, being a predictor of subsequent pneumonia caused by MRSA (a systematic review found a pooled sensitivity and specificity of 40.3% (95%CI 17.4e68.4) and 93.7% (95%CI 77.1e98.4 for VAP), respectively [28]. Recent literature reviews on antibiotic stewardship suggest that a negative nasal screening test for MRSA could avoid unnecessary and costly antibiotics [28,29]; however, no parallel conclusions with Gram stain morphology could be drawn as we had no data to support such a claim. Additionally, Gram staining could be an initial test to indicate respiratory samples on which rapid molecular tests for MRSA could be performed [4].…”

Formación de biofilm en aislados clínicos de Staphylococcus aureus y Staphylococcus epidermidis de Quito y el Puyo

“…Es una bacteria muy resistente al calor, la desecación y puede crecer en condiciones de alta salinidad. Esto facilita que el 20,00 % de la población sea portadora permanente de esta bacteria en fosas nasales y el 60,00 % actúan como portadores intermitentes (Carr et al 2018).…”