Evaluating the Impact of MRSA PCR Nasal Swabs on Early Antimicrobial De-escalation in Emergency Department Patients Nicole Odom, Tina Hardison, Julie Justo Palmetto Health Richland PGY1 Pharmacy - Columbia, SC
Background/Purpose: Methicillin-resistant Staphylococcus aureus polymerase chain reaction (PCR) nasal swab is recognized as a useful rapid diagnostic tool for early de-escalation of MRSA therapy in patients with pneumonia due to its high negative predicted value. Currently, there is a lack of comparative data regarding MRSA PCR nasal swab use in the emergency department (ED) and its impact on subsequent MRSA therapy in this specific patient population. The purpose of this study was to evaluate the duration of vancomycin therapy in emergency department patients with suspected or confirmed community-onset pneumonia with a negative MRSA PCR nasal swab as compared to patients with no performed MRSA PCR nasal swab.
Methodology: Eligible subjects in this retrospective, observational study were adult patients admitted from Palmetto Health Richland Emergency Department with suspected or confirmed community-onset bacterial pneumonia from August 1, 2016 to August 1, 2017, and who received IV vancomycin therapy in the emergency department. The primary objective was to compare the duration of vancomycin therapy in each group, i.e. negative MRSA PCR nasal swab vs. no MRSA PCR nasal swab. Secondary objectives included clinical outcomes (e.g. acute kidney injury, length of stay, duration of vancomycin therapy in patients with a positive MRSA PCR nasal swab) and pharmacist interventions. Univariable and multivariable logistic regression were used to assess the impact of MRSA PCR nasal swabs on the duration of vancomycin therapy and to adjust for other potential confounders.
Presentation Objective: Evaluate the duration of vancomycin therapy in emergency department patients with suspected or confirmed community-onset pneumonia with a negative MRSA PCR nasal swab as compared to patients with no MRSA PCR nasal swab.
Self-Assessment: What is the estimated negative predictive value of an MRSA PCR nasal swab?
