Nasal-Swab Results for Methicillin-Resistant Staphylococcus aureus and Associated Infections

Rioux, Josée; Edwards, Jenny; Bresee, Lauren; Abu-Ulba, Adrian; Yu, Stephen; Dersch‐Mills, Deonne; Wilson, Ben

doi:10.4212/cjhp.v70i2.1642

Cited by 15 publications

(17 citation statements)

References 20 publications

(35 reference statements)

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“…The sensitivity was 58.3% (95% confidence interval [CI] 28.6%-83.5%), specificity was 93.9% (95% CI 90.0%-96.3%), positive predictive value 30.4% (95% CI 14.1%-53.0%), negative predictive value 98.0% (95% CI 95.1%-99.3%). 15 Colonization with these organisms serves as an important risk factor for invasive infections. In our study septicemia was present in 67.8% of positive NIS samples.…”

Section: Discussionmentioning

confidence: 99%

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Routine Nosocomial Infection Screening among Onco-Hematological Patients- Does It Change Management?

2021

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Background: Hospital acquired infection (HAI) or Nosocomial Infection (NI) is a well-known entity among patients. The onco-hemological patients are immune-compromised and are at high risk of acquiring these infections. Routine screening of these patients for the presence of micro-organisms, their identification and sensitivity at the time of admission, and during stay, can help us in identifying infections and guiding therapy. Aims and Objective: This study was undertaken to find out the role of routine screening of admitted patients in oncology ward with empirical therapy during neutropenic episodes. Nosocomial Infection Screening (NIS) test was performed for these patients. This test was done to detect Methicillin Resistant Staphylococcus Aureus (MRSA) and Extended Spectrum Beta Lactamases (ESBL) producing Gram Negatives. The NIS results obtained were correlated with organisms isolated from blood cultures. Material and Methods: This retrospective study was done from period of May, 2013 to February,2017 in patients of oncology ward. Only those patients whose NIS test and blood culture was sent to the lab were included in the study. Result: A Total number of 52 NIS tests and blood cultures were included in the study. Among 28 positive NIS samples, 19 samples correlated with blood cultures. Among 24 negative NIS sample 17 correlated with blood cultures. The p value was 0.017, PPV 73%, NPV 64%. SPSS software was used to calculated values. Conclusion: This study showed that NIS test can be used as a tool for predictive marker for septic episodes in these patients.There is a higher probability of developing septic episodes with positive NISsamples.At the same time negative NIS result does not rule out infection.

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Section: Discussionmentioning

confidence: 99%

“…Other studies have also reported utilization of prediction of ESBL and MRSA infection from colonisation. 3,4,15 It is very critical to judge colonization from infection as inflammatory changes among immunocompromised is minimal. Carriage or colonization with normal commensal can prove lethal to these patients.…”

Section: Discussionmentioning

confidence: 99%

Routine Nosocomial Infection Screening among Onco-Hematological Patients- Does It Change Management?

2021

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“…Overall, there has been little literature published examining the performance of nasal MRSA screening for MRSA IAIs 9–12 . Although other studies have found high negative predictive values (NPV) of nasal MRSA screening for MRSA IAIs, the majority of this research did not occur in a critically ill population or only examined post‐surgical site infections 10 .…”

Section: Introductionmentioning

confidence: 99%

Performance of nasal methicillin‐resistant Staphylococcus aureus screening for intra‐abdominal infections in critically ill adult patients

et al. 2021

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Study Objective Intra‐abdominal infections (IAIs) are a common reason for intensive care unit (ICU) admissions, and methicillin‐resistant Staphylococcus aureus (MRSA) is an uncommon pathogen in IAIs. Although more data are available in the setting of non‐abdominal sources, there are limited data on the performance of nasal MRSA screening for MRSA IAIs. The primary objective of this study was to evaluate the performance of nasal MRSA screening for MRSA IAIs in critically ill adult patients. Design This was a multicenter, retrospective, cohort study. Setting A 14‐hospital healthcare system between January 1, 2014, and August 31, 2019. Patients Adult patients admitted to an ICU for at least 24 h with a diagnosis code for an IAI, a nasal MRSA surveillance screen within 30 days, and an intra‐abdominal culture were eligible for inclusion. Intervention The primary outcome was to evaluate the performance of nasal MRSA screening for MRSA IAIs by calculating the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Measurements and Main Results Out of 863 patients randomly screened, a total of 192 patients were included. The study population had a mean age of 60 (SD ±15) years, and 101 (53%) patients were male. Six (3.1%) patients were positive for an MRSA IAI, of which four (66.7%) demonstrated a positive nasal MRSA screen. A total of 186 (96.8%) patients were negative for a MRSA IAI, of which 19 (10.2%) were nasal MRSA‐positive and 167 (89.8%) were nasal MRSA‐negative. Nasal MRSA screening demonstrated the following performance: accuracy 89.1% (95% CI: 83.8%–93.1%), sensitivity 66.7% (95% CI: 22.3%–95.7%), specificity 89.8% (95% CI: 84.5%–93.7%), PPV 17.4% (95% CI: 9.4%–30.0%), and NPV 98.8% (95% CI: 96.4%–99.6%). There were no significant differences in clinical outcomes, including renal replacement‐free days, ICU and hospital length of stay, and in‐hospital mortality. Conclusions Among critically ill adult patients with IAIs, a negative nasal MRSA screen within 30 days may help to empirically exclude MRSA as a causative pathogen.

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“…Moreover, the NPV of MRSA nasal screening for MRSA wound infections was shown to be far lower than the NPV for MRSA pneumonia (7). Rioux et al (7) studied nasal swab screening for MRSA in predicting MRSA bloodstream, wound, and respiratory infections in 273 inpatients where the prevalence of MRSA infection in the study population was a low 4.4%. The NPV of the MRSA nasal screen for all MRSA infections was 98%.…”

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confidence: 99%

“…However, the NPV of the MRSA nasal screen specific for MRSA wound infections was only 71%. Consequently, MRSA nasal screening seems to be more valuable in regard to allowing for de-escalation or confirmation of need for continued MRSA therapy in patients with pneumonia than in those with wound infections (5,7).…”

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confidence: 99%

Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening: Clinical Use for Excluding Diabetic Foot Infection with MRSA

Sfeir

2020

Antimicrob Agents Chemother

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I read with great interest the recently published manuscript by Mergenhagen and colleagues (1) who retrospectively studied the use of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in predicting the absence of MRSA in clinical cultures collected from adults with diabetic foot infections. A total of 8,163 of cultures obtained from below the ankle of unique inpatients at the Veterans Affairs medical centers between 1 January 2007 and 1 January 2018 were included. MRSA was isolated in 7.5% of cultures, and a MRSA nasal screening test taken within 7 days of culture was positive in 17.8% of cultures. The negative predictive value (NPV) of MRSA nasal screening for MRSA diabetic foot infections was 89.6%.I agree with Mergenhagen et al. that a negative MRSA nares swab may be predictive of the absence of MRSA in a subsequent culture from a diabetic foot infection. This would be helpful for de-escalation of empirical anti-MRSA antibiotic treatment. However, clinicians should know the local prevalence of MRSA before making clinical decisions. As the prevalence decreases, the NPV increases (2). Note that Mergenhagen et al. found low MRSA infection rates of 7.5% in this cohort, which were lower than the rates of 15% to 30% described in previous studies (3,4). To that end, one could expect a lower NPV for MRSA nasal screening for MRSA diabetic foot infection in a population where MRSA is more prevalent. For instance, for a population in which the prevalence of MRSA is 30% (as described in previous studies), the new calculated NPV would decrease to 80.4%. That infers a probability of 19.6% for MRSA diabetic foot infection despite a negative MRSA nasal screen. I further agree with Mergenhagen et al.(1) that MRSA infections are associated with significant morbidity and mortality. Thus, failure to empirically treat MRSA while awaiting final tissue cultures would result in a high risk of treatment failure.The Infectious Disease Society of America (IDSA) guidelines for management of diabetic foot infections published in 2012 recommend empirical MRSA coverage for all severe diabetic foot infections (5). For mild and moderate diabetic foot infections and in the absence of history of MRSA infection, IDSA recommends empirical coverage for MRSA if the local prevalence of MRSA is high enough, i.e., 50% and 30%, respectively (5). This again emphasizes the importance of knowledge of local epidemiology and the risk factors for MRSA infections in treating empirically diabetic foot infections.Yet, the threshold of an acceptable NPV for optimal therapeutic decisions has not been standardized, and it often differs by clinician. Data supporting MRSA nasal screening for empirical MRSA coverage in patients with pneumonia are robust (5, 6). The NPV of MRSA nasal screening was high, at 98.6%, in a population where the prevalence of MRSA was 10.5% (6). In this case, one may feel very confident to de-escalate MRSA coverage in treating pneumonia if the MRSA nasal screen is negative.

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Nasal-Swab Results for Methicillin-Resistant Staphylococcus aureus and Associated Infections

Cited by 15 publications

References 20 publications

Routine Nosocomial Infection Screening among Onco-Hematological Patients- Does It Change Management?

Routine Nosocomial Infection Screening among Onco-Hematological Patients- Does It Change Management?

Performance of nasal methicillin‐resistant Staphylococcus aureus screening for intra‐abdominal infections in critically ill adult patients

Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening: Clinical Use for Excluding Diabetic Foot Infection with MRSA

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