In this episode, I’ll discuss an article on using MRSA nasal swab testing to optimize pneumonia treatment with empiric vancomycin.
Many patients who are critically ill with community-acquired pneumonia are given vancomycin due to concern for MRSA as a causative pathogen. MRSA polymerase chain reaction (PCR) nasal swab testing can be used to guide vancomycin de-escalation so that unnecessary coverage in low-risk patients is not continued.
A group of authors published in Clinical Infectious Diseases a prospective single-center randomized trial to evaluate the addition of MRSA nares PCR testing in patients with severe CAP following ICU admission.
Just under 300 patients were randomized 1:1 to receive usual care with or without an MRSA PCR nasal swab. The primary outcome was vancomycin-free hours alive.
In the group of patients randomized to MRSA PCR nasal swabs, the test had a 98.9% negative predictive value. Despite this, vancomycin-free hours alive was 105.7 in the control arm and 109.7 in the intervention arm, a difference that was not statistically significant.
The authors concluded:
Despite MRSA PCR nasal swab testing demonstrating a high NPV in this critically ill population, MRSA PCR nasal swab testing did not decrease the duration of vancomycin use or 30-day mortality among ICU patients with suspected CAP. Additional clinician education and antimicrobial stewardship interventions might be needed to reduce vancomycin use in this patient population.
While a single center study like this is not automatically generalizable, it is a good idea to examine how nasal MRSA swabs are being used in your institution. Are they ordered but not acted upon like in this study? If so, that is a golden opportunity for pharmacists to enhance the care given to critically ill patients with community acquired pneumonia.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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