Publication: The role of negative methicillin-resistant staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients
2
Issued Date
2018-03-01
Resource Type
ISSN
15596834
0899823X
0899823X
Other identifier(s)
2-s2.0-85051358740
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Infection Control and Hospital Epidemiology. Vol.39, No.3 (2018), 290-296
Suggested Citation
Darunee Chotiprasitsakul, Pranita D. Tamma, Avinash Gadala, Sara E. Cosgrove The role of negative methicillin-resistant staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients. Infection Control and Hospital Epidemiology. Vol.39, No.3 (2018), 290-296. doi:10.1017/ice.2017.308 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/46904
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
The role of negative methicillin-resistant staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients
Abstract
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVES The role of methicillin-resistant Staphylococcus aureus (MRSA) nasal surveillance swabs (nasal swabs) in guiding decisions about prescribing vancomycin is unclear. We aimed to determine the likelihood that patients with negative MRSA nasal swabs develop subsequent MRSA infections; to assess avoidable vancomycin days for patients with negative nasal swabs; and to identify risk factors for having a negative nasal swab and developing a MRSA infection during the intensive care unit (ICU) stay. METHODS This retrospective cohort study was conducted in 6 ICUs at a tertiary-care hospital from December 2013 through June 2015. The negative predictive value (NPV), defined as the ability of a negative nasal swab to predict no subsequent MRSA infection, was calculated. Days of vancomycin continued or restarted after 3 days from the collection time of the first negative nasal swab were determined. A matched case-control study identified risk factors for having a negative nasal swab and developing MRSA infection. RESULTS Of 11,441 patients with MRSA-negative nasal swabs, the rate of subsequent MRSA infection was 0.22%. A negative nasal swab had a NPV of 99.4% (95% confidence interval [CI], 99.1%-99.6%). Vancomycin was continued or started after nasal swab results were available in 1,431 patients, translating to 7,364 vancomycin days. No risk factors associated with MRSA infection were identified. CONCLUSIONS In our hospital with a low prevalence of MRSA transmission, a negative MRSA nasal swab was helpful in identifying patients with low risk of MRSA infection in whom empiric vancomycin therapy could be stopped and in whom the subsequent initiation of vancomycin therapy during an ICU admission could be avoided.