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1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a relevant pathogen for patients with pneumonia in the presence of certain risk factors. Empiric broad-spectrum antimicrobial therapy, including anti-MRSA therapy, is frequently initiated in patients hospitalized with pneumonia. The l...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252799/ http://dx.doi.org/10.1093/ofid/ofy210.1288 |
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author | Olson, Kelsey Revolinski, Sara Wainaina, J Njeri Luzi, Jessica Huang, Angela |
author_facet | Olson, Kelsey Revolinski, Sara Wainaina, J Njeri Luzi, Jessica Huang, Angela |
author_sort | Olson, Kelsey |
collection | PubMed |
description | BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a relevant pathogen for patients with pneumonia in the presence of certain risk factors. Empiric broad-spectrum antimicrobial therapy, including anti-MRSA therapy, is frequently initiated in patients hospitalized with pneumonia. The low yield of respiratory cultures makes antimicrobial de-escalation difficult, potentially leading to extended durations of anti-MRSA therapy and increasing risk for significant drug-related adverse effects. A polymerase chain reaction (PCR) test that was previously utilized for nasal MRSA screening was internally validated to identify the presence of MRSA in respiratory specimens within 2 hours of sample collection. The primary objective of this study was to determine the effect of this respiratory PCR test on duration of anti-MRSA therapy in nonintensive care unit (ICU) patients hospitalized with pneumonia. METHODS: Implementation of the PCR test in non-ICU units occurred December 1, 2017. During the post-intervention (INT) period (December 1, 2017–March 31, 2018), PCR results were evaluated daily by antimicrobial stewardship and decentralized staff pharmacists for therapy de-escalation opportunities, with recommendations communicated to prescribers. The pre-INT group (December 1, 2016–March 31, 2017) consisted of non-ICU patients hospitalized with pneumonia who received anti-MRSA therapy for at least 48 hours, or who qualified for anti-MRSA therapy per institutional guidelines. RESULTS: A total of 169 patients were evaluated; 109 in the post-INT group and 60 in the pre-INT group. Anti-MRSA therapy was administered to 74 patients (68%) in the post-INT group, compared with 56 patients (93%) in the pre-INT group. The median duration of anti-MRSA therapy post-INT was 23.5 hours, which was significantly shorter than the pre-INT duration of 55.5 hours (P < 0.0001). The post-INT group also had significantly less vancomycin-induced nephrotoxicity (P < 0.0383) and a shorter time to targeted therapy (P < 0.0001). No difference in 30-day all-cause mortality was observed (P < 0.1338). CONCLUSION: Utilization of a PCR test to detect MRSA in respiratory specimens decreased duration of anti-MRSA therapy in non-ICU patients hospitalized with pneumonia. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6252799 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62527992018-11-28 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples Olson, Kelsey Revolinski, Sara Wainaina, J Njeri Luzi, Jessica Huang, Angela Open Forum Infect Dis Abstracts BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a relevant pathogen for patients with pneumonia in the presence of certain risk factors. Empiric broad-spectrum antimicrobial therapy, including anti-MRSA therapy, is frequently initiated in patients hospitalized with pneumonia. The low yield of respiratory cultures makes antimicrobial de-escalation difficult, potentially leading to extended durations of anti-MRSA therapy and increasing risk for significant drug-related adverse effects. A polymerase chain reaction (PCR) test that was previously utilized for nasal MRSA screening was internally validated to identify the presence of MRSA in respiratory specimens within 2 hours of sample collection. The primary objective of this study was to determine the effect of this respiratory PCR test on duration of anti-MRSA therapy in nonintensive care unit (ICU) patients hospitalized with pneumonia. METHODS: Implementation of the PCR test in non-ICU units occurred December 1, 2017. During the post-intervention (INT) period (December 1, 2017–March 31, 2018), PCR results were evaluated daily by antimicrobial stewardship and decentralized staff pharmacists for therapy de-escalation opportunities, with recommendations communicated to prescribers. The pre-INT group (December 1, 2016–March 31, 2017) consisted of non-ICU patients hospitalized with pneumonia who received anti-MRSA therapy for at least 48 hours, or who qualified for anti-MRSA therapy per institutional guidelines. RESULTS: A total of 169 patients were evaluated; 109 in the post-INT group and 60 in the pre-INT group. Anti-MRSA therapy was administered to 74 patients (68%) in the post-INT group, compared with 56 patients (93%) in the pre-INT group. The median duration of anti-MRSA therapy post-INT was 23.5 hours, which was significantly shorter than the pre-INT duration of 55.5 hours (P < 0.0001). The post-INT group also had significantly less vancomycin-induced nephrotoxicity (P < 0.0383) and a shorter time to targeted therapy (P < 0.0001). No difference in 30-day all-cause mortality was observed (P < 0.1338). CONCLUSION: Utilization of a PCR test to detect MRSA in respiratory specimens decreased duration of anti-MRSA therapy in non-ICU patients hospitalized with pneumonia. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6252799/ http://dx.doi.org/10.1093/ofid/ofy210.1288 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Olson, Kelsey Revolinski, Sara Wainaina, J Njeri Luzi, Jessica Huang, Angela 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples |
title | 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples |
title_full | 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples |
title_fullStr | 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples |
title_full_unstemmed | 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples |
title_short | 1458. A Single-Center Quasi-Experimental Study to Evaluate the Impact of Utilizing Rapid Diagnostic Technology to Detect Methicillin-Resistant Staphylococcus aureus in Respiratory Culture Samples |
title_sort | 1458. a single-center quasi-experimental study to evaluate the impact of utilizing rapid diagnostic technology to detect methicillin-resistant staphylococcus aureus in respiratory culture samples |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252799/ http://dx.doi.org/10.1093/ofid/ofy210.1288 |
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