The Clinical Utility of MRSA Nasal Surveillance Swabs in Ruling-Out MRSA Infections in Children

Diseroad, Emily R.; Rebecca, G; Hsu, Alice J.

doi:10.1093/jpids/piad011

Cited by 8 publications

(3 citation statements)

References 10 publications

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“…A recently published study at the Johns Hopkins Hospital identified a NPV of 99.4% for all indications combined in 165 hospitalized children. 9 Similarly, their inclusion criteria was also limited to include only those patients who had a presumed infectious diagnosis and excluded those who received MNS for surveillance. Moreover, they utilized a culture-based MNS test like our study.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship

Braga,

Rajapakse,

Heyliger

et al. 2023

Pediatric Infectious Disease Journal

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections and empiric treatment regimens in children frequently include an anti-MRSA antibiotic. Studies in adults have demonstrated a high negative predictive value (NPV) of MRSA nasal swabs (MNS) in a variety of infectious syndromes. Negative MNS have been utilized as a tool to guide de-escalation of anti-MRSA antibiotics in adults, especially in those with lower respiratory tract infections, but data in children is minimal. The primary objective of this study was to determine the NPV and positive predictive value (PPV) of MNS in children hospitalized for treatment of an infection. Methods: This was a single-site, retrospective cohort study of pediatric patients admitted with a suspected infectious diagnosis who had an MNS performed during their hospitalization between June 1, 2018 and November 25, 2022. Results: This study identified 172 patients who met the inclusion criteria. Eleven (6.4%) nasal swabs were positive for MRSA and 10 (5.8%) microbiological cultures from suspected sources of infection were identified to be positive for MRSA. The MNS was found to have a sensitivity of 20%, specificity of 94%, PPV of 18% and NPV of 95% for all sites of infection. Conclusion: MNS has a high NPV and low PPV in children. MNS can be utilized as an antimicrobial stewardship tool to guide the safe de-escalation of anti-MRSA antibiotics in children.

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Section: Discussionmentioning

confidence: 99%

Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship

Braga,

Rajapakse,

Heyliger

et al. 2023

Pediatric Infectious Disease Journal

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“…1 Their key finding of a high negative predictive value (NPV) (95%) of MNS for all combined indications adds to 2 previously and 1 since published studies in children confirming high NPVs (95.5%-100%) for infections that primarily included lower respiratory tract infections (LRTI) and skin and soft tissue infections (SSTI). [2][3][4][5] We applaud Braga for being able to calculate the first-time infection-specific NPVs of MNS in children with LRTIs [95% (n = 46)], SSTIs [96% (n = 24)] and bone and joint infections (BJIs) [91% (n = 22)]. We concur with their conclusions that MNS in children may have a utility beyond LRTIs including SSTIs and BJIs as well as with their call for more data specifically for those 2 latter infections.…”

Section: What About Hospitalized Children With Osteomyelitis?mentioning

confidence: 99%

Section: To the Editorsmentioning

confidence: 99%

Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship: What About Hospitalized Children With Osteomyelitis?

Sands,

Iacono,

Hagmann

2024

Pediatric Infectious Disease Journal

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Predictive Value of Methicillin-Resistant Staphylococcus aureus Nasal Swab PCR Assay for MRSA Infection in Critically Ill Pediatric Patients

Crawford,

Pertsovskaya,

Shanklin

et al. 2023

Journal of the Pediatric Infectious Diseases Society

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Background Critically ill pediatric patients are frequently initiated methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics during infection evaluation even though MRSA infections are rare in many patient populations. The MRSA nasal swab polymerase chain reaction assay (MRSA-NS-PCR) is a test that has been shown to have a high negative predictive value (NPV) for MRSA infection in adults. This study evaluated the diagnostic test characteristics of the MRSA-NS-PCR in predicting the presence of MRSA infection in critically ill pediatric patients. Study Design A retrospective cohort study was performed in a 44-bed pediatric intensive care unit (PICU) between 2013 and 2017. 3860 pediatric patients (54% male, median age 4 years [IQR 1–11 years]) admitted to the PICU who met pediatric systemic inflammatory response syndrome (pSIRS) criteria, were screened with a MRSA-NS-PCR, and had cultures obtained within seven days of MRSA-NS-PCR collection were included. Predictive values and post-test probabilities of the MRSA-NS-PCR for MRSA infection were calculated. Results MRSA-NS-PCR was positive in 8.6% of patients. MRSA infection was identified in 40 patients, equaling an incidence rate of 2 per 1000 patient days. The MRSA-NS-PCR demonstrated a positive predictive value (PPV) of 9.7%, a NPV of 99.8%, and a post-test probability for a negative test of 0.2% for MRSA infection. Conclusions The MRSA-NS-PCR has a poor PPV but a high NPV for MRSA infection in PICU patients when the incidence of MRSA infection is low. Creation of protocols to guide antimicrobial selection based on MRSA-NS-PCR results may lead to improved antimicrobial stewardship and significant risk reduction.

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The Clinical Utility of MRSA Nasal Surveillance Swabs in Ruling-Out MRSA Infections in Children

Cited by 8 publications

References 10 publications

Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship

Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship

Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship: What About Hospitalized Children With Osteomyelitis?

Predictive Value of Methicillin-Resistant Staphylococcus aureus Nasal Swab PCR Assay for MRSA Infection in Critically Ill Pediatric Patients

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