Rapid testing for methicillin-resistant Staphylococcus aureus: Implications for antimicrobial stewardship

Geiger, Krystina; Brown, Jack

doi:10.2146/ajhp110724

Cited by 15 publications

(4 citation statements)

References 29 publications

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“…Modern polymerase chain reaction testing methods are improving time to identification of infectious pathogens including Staphylococcus aureus. There are several MRSA tests currently available in the United States [28]. Of these, the Xpert MRSA/ SA BC test has demonstrated improvements in time to initiation of antistaphylococcal therapy for MSSA (mean, 5.5 hours vs 49 hours) and reduced empirical initiation of vancomycin therapy [29].…”

Section: Impact Of Rapid Diagnostic Testing On Empirical Therapymentioning

confidence: 99%

The Empirical Combination of Vancomycin and a -Lactam for Staphylococcal Bacteremia

McConeghy¹,

Bleasdale

Rodvold

2013

Clinical Infectious Diseases

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The high prevalence of methicillin resistance among Staphylococcus aureus bacteremias leads to common use of vancomycin as empirical therapy. However, investigators have reported poor outcomes with vancomycin treatment for methicillin-susceptible Staphylococcus aureus bacteremia. We review the evidence supporting empirical combination of both vancomycin and a β-lactam agent for Staphylococcus aureus bacteremia. Vancomycin therapy for methicillin-susceptible Staphylococcus aureus bacteremia is associated with 2-3 times the risk of morbidity and mortality compared to an antistaphylococcal penicillin (oxacillin and nafcillin) or first-generation cephalosporin (cefazolin). De-escalation of empirical vancomycin to definitive β-lactam therapy still appears inferior to initial β-lactam therapy. Although there is no clinical trial supporting combination therapy, a scientific rationale for benefit exists and should be weighed against the risks (adverse events, antibiotic resistance, and cost) of additional pharmacotherapy. The empirical combination of vancomycin and a β-lactam (either nafcillin, oxacillin, or cefazolin) for staphylococcal bacteremia may improve infection-related clinical outcomes.

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Section: Impact Of Rapid Diagnostic Testing On Empirical Therapymentioning

confidence: 99%

The Empirical Combination of Vancomycin and a -Lactam for Staphylococcal Bacteremia

McConeghy¹,

Bleasdale

Rodvold

2013

Clinical Infectious Diseases

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“…With the many rapid tests that are available, choosing which test to use at an institution will depend on a variety of factors, including cost, reported specificity and sensitivity, time to test result, U.S. Food and Drug Administration-approved indications, and the data available to support their use with regard to improvement of patient outcomes (8). Their role in antimicrobial stewardship ultimately relates to how they promote the goals of stewardship, namely, improving patient care and health care outcomes (8). For this study, we utilized CHROMagar medium, which, although not as rapid as molecular tests, can cost 5 to 20 times less than a molecular assay.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

et al. 2013

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e Staphylococcus aureus is a common cause of bacteremia, with a substantial impact on morbidity and mortality. Because of increasing rates of methicillin-resistant Staphylococcus aureus, vancomycin has become the standard empirical therapy. However, beta-lactam antibiotics remain the best treatment choice for methicillin-susceptible strains. Placing patients quickly on the optimal therapy is one goal of antimicrobial stewardship. This retrospective, observational, single-center study compared 33 control patients utilizing only traditional full-susceptibility methodology to 22 case patients utilizing rapid methodology with CHROMagar medium to detect and differentiate methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains hours before full susceptibilities were reported. The time to targeted therapy was statistically significantly different between control patients (mean, 56.5 ؎ 13.6 h) and case patients (44.3 ؎ 17.9 h) (P ‫؍‬ 0.006). Intensive care unit status, time of day results emerged, and patient age did not make a difference in time to targeted therapy, either singly or in combination. Neither length of stay (P ‫؍‬ 0.61) nor survival (P ‫؍‬ 1.0) was statistically significantly different. Rapid testing yielded a significant result, with a difference of 12.2 h to targeted therapy. However, there is still room for improvement, as the difference in time to susceptibility test result between the full traditional methodology and CHROMagar was even larger (26.5 h). This study supports the hypothesis that rapid testing plays a role in antimicrobial stewardship by getting patients on targeted therapy faster.

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“…Compared to standard culture and susceptibility testing methods that may take 48À96 hours, molecular MRSA assays (based on PCR or bacteriophage technology) can dramatically shorten laboratory turnaround times (to 1À5 hours) [39]. The recent development of real-time PCR has enabled reliable and rapid identification, characterization and quantification of clinical isolates of S. aureus, and supports the selection and implementation of effective infection control strategies (including the appropriate use of antibiotics).…”

Section: Staphylococcus Aureus Identificationmentioning

confidence: 99%

Enterotoxin-Producing Staphylococcus aureus

Liu¹

2015

Molecular Medical Microbiology

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Rapid testing for methicillin-resistant Staphylococcus aureus: Implications for antimicrobial stewardship

Cited by 15 publications

References 29 publications

The Empirical Combination of Vancomycin and a -Lactam for Staphylococcal Bacteremia

The Empirical Combination of Vancomycin and a -Lactam for Staphylococcal Bacteremia

Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

Enterotoxin-Producing Staphylococcus aureus

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