title: Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia.
abstract: The objective of this study was to evaluate the impact of pharmacist-ordered methicillin-resistantStaphylococcus aureus(MRSA) PCR testing on the duration of empirical MRSA-targeted antibiotic therapy in patients with suspected pneumonia. This is a retrospective analysis of patients who received vancomycin or linezolid for suspected pneumonia before and after the implementation of a pharmacist-driven protocol for nasal MRSA PCR testing. Patients were included if they were adults of >18 years of age and initiated on vancomycin or linezolid for suspected MRSA pneumonia. The primary endpoint was the duration of vancomycin or linezolid therapy. After screening 368 patients, 57 patients met inclusion criteria (27 pre-PCR and 30 post-PCR). Baseline characteristics were similar between the two groups, with the majority of patients classified as having health care-associated pneumonia (68.4%). The use of the nasal MRSA PCR test reduced the mean duration of MRSA-targeted therapy by 46.6 h (74.0 ± 48.9 h versus 27.4 ± 18.7 h; 95% confidence interval [CI], 27.3 to 65.8 h;P< 0.0001). Fewer patients in the post-PCR group required vancomycin serum levels and dose adjustment (48.1% versus 16.7%;P= 0.02). There were no significant differences between the pre- and post-PCR groups regarding days to clinical improvement (1.78 ± 2.52 versus 2.27 ± 3.34;P= 0.54), length of hospital stay (11.04 ± 9.5 versus 8.2 ± 7.8;P= 0.22), or hospital mortality (14.8% versus 6.7%;P= 0.41). The use of nasal MRSA PCR testing in patients with suspected MRSA pneumonia reduced the duration of empirical MRSA-targeted therapy by approximately 2 days without increasing adverse clinical outcomes.
authors.affiliation: Texas Health Resources Presbyterian Hospital of Dallas, Department of Pharmacy, Dallas, Texas, USA.|Texas Tech University Health Science Center, Dallas, Texas, USA.
authors.forename: Nidhu
authors.initials: N
authors.lastname: Baby
authors.affiliation: Texas Health Resources Presbyterian Hospital of Dallas, Department of Pharmacy, Dallas, Texas, USA andrewfaust@texashealth.org.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Faust
authors.affiliation: Texas Health Resources Presbyterian Hospital of Dallas, Department of Pharmacy, Dallas, Texas, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Smith
authors.affiliation: Texas Health Resources Presbyterian Hospital of Dallas, Department of Pharmacy, Dallas, Texas, USA.
authors.forename: Lyndsay A
authors.initials: LA
authors.lastname: Sheperd
authors.affiliation: Texas Health Resources Presbyterian Hospital of Dallas, Department of Laboratory Services, Dallas, Texas, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Knoll
authors.affiliation: Texas Tech University Health Science Center, Dallas, Texas, USA.|Texas Health Resources Presbyterian Hospital of Dallas, Department of Internal Medicine, Dallas, Texas, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics*; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013997:Time Factors; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Staphylococcus aureus; antimicrobial stewardship; methicillin-resistant Staphylococcus aureus; pneumonia; vancomycin