title: Does universal active MRSA surveillance influence anti-MRSA antibiotic use? A retrospective analysis of the treatment of patients admitted with suspicion of infection at Veterans Affairs Medical Centers between 2005 and 2010.
abstract: OBJECTIVE
  After the implementation of an active surveillance programme for MRSA in US Veterans Affairs (VA) Medical Centers, there was an increase in vancomycin use. We investigated whether positive MRSA admission surveillance tests were associated with MRSA-positive clinical admission cultures and whether the availability of surveillance tests influenced prescribers' ability to match initial anti-MRSA antibiotic use with anticipated MRSA results from clinical admission cultures.
  
  
  METHODS
  Analyses were based on barcode medication administration data, microbiology data and laboratory data from 129 hospitals between January 2005 and September 2010. Hospitalized patient admissions were included if clinical cultures were obtained and antibiotics started within 2 days of admission. Mixed-effects logistic regression was used to examine associations between positive MRSA admission cultures and (i) admission MRSA surveillance test results and (ii) initial anti-MRSA therapy.
  
  
  RESULTS
  Among 569,815 included admissions, positive MRSA surveillance tests were strong predictors of MRSA-positive admission cultures (OR 8.5; 95% CI 8.2-8.8). The negative predictive value of MRSA surveillance tests was 97.6% (95% CI 97.5%-97.6%). The diagnostic OR between initial anti-MRSA antibiotics and MRSA-positive admission cultures was 3.2 (95% CI 3.1-3.4) for patients without surveillance tests and was not significantly different for admissions with surveillance tests.
  
  
  CONCLUSIONS
  The availability of nasal MRSA surveillance tests in VA hospitals did not seem to improve the ability of prescribers to predict the necessity of initial anti-MRSA treatment despite the high negative predictive value of MRSA surveillance tests. Prospective trials are needed to establish the safety and effectiveness of using MRSA surveillance tests to guide antibiotic therapy.
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA makoto.jones@va.gov.
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Huttner
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Leecaster
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Huttner
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Damal
authors.affiliation: University of Utah Department of Family and Preventative Medicine, Salt Lake City, UT, USA.
authors.forename: Windy
authors.initials: W
authors.lastname: Tanner
authors.affiliation: VA Reno Medical Center and University of Nevada Reno, Reno, NV, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nielson
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
authors.affiliation: VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: Clinical Pharmacy Service, Veterans Affairs Medical Center, Boise, ID, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Madaras-Kelly
authors.affiliation: VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004358:Drug Therapy / Q000379:methods; D004363:Drug Utilization; D062665:Epidemiological Monitoring; D006787:Hospitals, Veterans; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: definitive treatment; empirical treatment; vancomycin
references.citation: Infect Control Hosp Epidemiol. 2012 Apr;33(4):346-53
references.pmid: 22418629
references.citation: Clin Infect Dis. 2007 Mar 1;44(5):664-70
references.pmid: 17278056
references.citation: Arch Intern Med. 2008 Nov 10;168(20):2254-60
references.pmid: 19001203
references.citation: JAMA. 2010 Aug 11;304(6):641-8
references.pmid: 20699455
references.citation: J Antimicrob Chemother. 2013 Oct;68(10):2393-9
references.pmid: 23681271
references.citation: N Engl J Med. 2011 Apr 14;364(15):1407-18
references.pmid: 21488763
references.citation: JAMA. 2012 Jul 4;308(1):50-9
references.pmid: 22760291
references.citation: J Clin Epidemiol. 2003 Nov;56(11):1129-35
references.pmid: 14615004
references.citation: Infect Control Hosp Epidemiol. 2009 Apr;30(4):380-2
references.pmid: 19239378
references.citation: Infect Control Hosp Epidemiol. 2012 Apr;33(4):362-7
references.pmid: 22418631
references.citation: J Infect Dis. 2007 Feb 1;195(3):330-8
references.pmid: 17205470
references.citation: N Engl J Med. 2011 Aug 25;365(8):761; author reply 764-6
references.pmid: 21864178
references.citation: Antimicrob Agents Chemother. 2013 Mar;57(3):1163-8
references.pmid: 23254432
references.citation: Am J Public Health. 2011 Sep;101(9):1635-42
references.pmid: 21778493
references.citation: BMC Infect Dis. 2011 May 20;11:138
references.pmid: 21599908
references.citation: In Vivo. 2012 May-Jun;26(3):469-72
references.pmid: 22523301
references.citation: Clin Microbiol Infect. 2010 May;16(5):425-31
references.pmid: 19689469
references.citation: Clin Infect Dis. 2001 May 15;32 Suppl 2:S114-32
references.pmid: 11320452
references.citation: J Antimicrob Chemother. 2009 Sep;64 Suppl 1:i11-7
references.pmid: 19675013
references.citation: N Engl J Med. 2013 Jun 13;368(24):2255-65
references.pmid: 23718152
references.citation: N Engl J Med. 2011 Apr 14;364(15):1419-30
references.pmid: 21488764
references.citation: Clin Ther. 2012 Jan;34(1):124-37
references.pmid: 22154196
references.citation: BMC Med Inform Decis Mak. 2012 Jul 11;12:34
references.pmid: 22533507
references.citation: N Engl J Med. 2014 Apr 17;370(16):1524-31
references.pmid: 24738669
references.citation: Antimicrob Agents Chemother. 2010 Aug;54(8):3143-8
references.pmid: 20479207
references.citation: J Hosp Infect. 2007 Jan;65(1):24-8
references.pmid: 17145100
references.citation: Clin Microbiol Infect. 2012 Feb;18(2):E31-3
references.pmid: 22192160