Evaluation of the negative predictive value of methicillin-resistant <i>Staphylococcus aureus</i> nasal swab screening in patients with acute myeloid leukemia

Perreault, Sarah; Binks, Bailee; McManus, Dayna; Topal, Jeffrey

doi:10.1017/ice.2020.1299

Cited by 8 publications

(6 citation statements)

References 13 publications

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“… 50 , 51 Neutropenic patients have generally not been well represented in these studies, but there are now three published studies evaluating the predictive value of PCR-based MRSA nasal carriage assessment and MRSA infection in neutropenic patients. 52 – 54 All three studies found a low prevalence of MRSA colonization and infection. The MRSA PCR demonstrated a negative predictive value of 97.5% to 99%, consistent with studies in non-neutropenic patients.…”

Section: Updates In Diagnosismentioning

confidence: 95%

Section: Updates In Diagnosismentioning

confidence: 99%

“…Emerging data support the utilization of MRSA screening to aid in de-escalation of vancomycin therapy and clinicians should work to incorporate them into clinical protocols and practice, particularly if local prevalence of MRSA infection is low. [52][53][54] Fungal diagnostics Neutropenic patients are at a significant risk for invasive fungal diseases (IFD) including invasive aspergillus (IA) and systemic candidiasis and candidemia. Current biomarkers recommended by guidelines include aspergillus galactomannan (GM) and 1-3-β-D-glucan.…”

Section: Mrsa Pcrmentioning

confidence: 99%

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Approach to fever in patients with neutropenia: a review of diagnosis and management

Keck

Wingler

Cretella

et al. 2022

Therapeutic Advances in Infection

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Febrile neutropenia (FN) is associated with mortality rates as high as 40%, highlighting the importance of appropriate clinical management in this patient population. The morbidity and mortality of FN can be attributed largely to infectious processes, with specific concern for infections caused by pathogens with antimicrobial resistance. Expeditious identification of responsible pathogens and subsequent initiation of empiric antimicrobial therapy is imperative. There are four commonly used guidelines, which have variable recommendations for empiric therapy in these populations. All agree that changes could be made once patients are stable and/or with an absolute neutrophil count (ANC) over 500 cells/mcL. Diagnostic advances have the potential to improve knowledge of pathogens responsible for FN and decrease time to results. In addition, more recent data show that rapid de-escalation or discontinuation of empiric therapy, regardless of ANC, may reduce days of therapy, adverse effects, and cost, without affecting clinical outcomes. Antimicrobial and diagnostic stewardship should be performed to identify, utilize, and respond to appropriate rapid diagnostic tests that will aid in the definitive management of this population.

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Section: Updates In Diagnosismentioning

confidence: 95%

Section: Updates In Diagnosismentioning

confidence: 99%

Section: Mrsa Pcrmentioning

confidence: 99%

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Approach to fever in patients with neutropenia: a review of diagnosis and management

Keck

Wingler

Cretella

et al. 2022

Therapeutic Advances in Infection

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“…Despite the critical concerns associated with importation and nosocomial infection cases, identifying them rapidly and accurately still remains a challenging problem. Current methods to identify them include surveillance tests 13,14 , machine learning-based methods 15,16 , and transmission modeling-based methods [17][18][19][20][21][22][23] . However, they all suffer from unavoidable drawbacks.…”

Section: Introductionmentioning

confidence: 99%

Identifying Importation and Asymptomatic Spreaders of Multi-drug Resistant Organisms in Hospital Settings

Prakash,

Cui,

Heavey

et al. 2024

Preprint

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Healthcare-associated infections (HAIs) due to multi-drug resistant organisms (MDROs) are a significant burden to the healthcare system. Patients are sometimes already infected at the time of admission to the hospital (referred to as “importation”), and additional patients might get infected in the hospital through transmission (“nosocomial infection”). Since many of these importation and nosocomial infection cases may present no symptoms (i.e., “asymptomatic”), rapidly identifying them is difficult since testing is limited and incurs significant delays. Although there has been a lot of work on examining the utility of both mathematical models of transmission and machine learning for identifying patients at risk of MDRO infections in recent years, these methods have limited performance and suffer from different drawbacks: Transmission modeling-based methods do not make full use of rich data contained in electronic health records (EHR), while machine learning-based methods typically lack information about mechanistic processes. In this work, we propose NeurABM, a new framework which integrates both neural networks and agent-based models (ABM) to combine the advantages of both modeling-based and machine learning-based methods. NeurABM simultaneously learns a neural network model for patient-level prediction of importation, as well as the ABM model which is used for identifying infections. Our results demonstrate that NEURABM identifies importation and nosocomial infection cases more accurately than existing methods.

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“…This has allowed for the confident de-escalation and avoidance of empiric anti-MRSA treatment before the finalization of cultures [ 3 , 4 ]. However, MRSA nares screening is not well validated in high-risk individuals, including those with neutropenia, hematopoietic stem cell transplant (HSCT) recipients, and solid organ transplant (SOT) recipients [ 5 , 6 ].…”

mentioning

confidence: 99%

Assessing the Predictive Value of Methicillin-Resistant Staphylococcus aureus Nares Colonization Among Transplant Recipients and Patients With Neutropenia

Shaw,

Zander,

Ronnie

et al. 2024

Open Forum Infectious Diseases

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Background MRSA nares screening has been shown to be a powerful antibiotic stewardship tool for MRSA infections within seven days of screening across a variety of anatomical locations given the high negative predictive value (NPV). However, the utility outside of seven days and among transplant recipients and patients with neutropenia is less clear. Methods Retrospective cohort study across Veteran Affairs medical centers in the United States from January 1, 2007 to January 1, 2023 of patients tested for MRSA colonization and who had a subsequent positive bacterial culture within 28 days of MRSA screening. Sensitivity, specificity, positive predictive value, and NPV were calculated across different time points and anatomical culture locations. Results The cohort consisted of 686,174 patients, 6,277,437 MRSA nares tests, and 2,446,766 positive bacterial cultures within 28 days of MRSA testing. The NPV of MRSA nares screening for ruling out a MRSA infection within 28 days was 95.8% across all anatomical culture sites. The NPV amongst patients with neutropenia was 97.9%, and solid organ and hemopoietic stem cell transplant was 97.5%. Conclusion MRSA nares screening can reliably be used for de-escalation of anti-MRSA therapy within 28 days of bacterial culture for all patients, including solid organ and hematopoietic transplant recipients and patients with neutropenia.

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Evaluation of the negative predictive value of methicillin-resistant Staphylococcus aureus nasal swab screening in patients with acute myeloid leukemia

Cited by 8 publications

References 13 publications

Approach to fever in patients with neutropenia: a review of diagnosis and management

Approach to fever in patients with neutropenia: a review of diagnosis and management

Identifying Importation and Asymptomatic Spreaders of Multi-drug Resistant Organisms in Hospital Settings

Assessing the Predictive Value of Methicillin-Resistant Staphylococcus aureus Nares Colonization Among Transplant Recipients and Patients With Neutropenia

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