Can Nasal Methicillin-Resistant Staphylococcus aureus Screening Be Used to Avoid Empiric Vancomycin Use in Intra-Abdominal Infection?

Sara A. Hennessy, Puja M. Shah, Christopher A. Guidry, Stephen W. Davies, Tjasa Hranjec, Robert G. Sawyer

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Vancomycin is used widely as empiric therapy for gram-positive organisms in patients with an intra-abdominal infection (IAI), even in those with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. Potential adverse effects of vancomycin include nephrotoxicity, increased cost, and bacterial resistance. We hypothesized that MRSA nasal screening could be used to predict patients with a MRSA IAI and used to avoid unnecessary empiric vancomycin use. Methods: A surgical infections database collected prospectively from a single institution was reviewed for all IAIs between January 1, 2000-December 31, 2011. Patients with and without MRSA obtained from abdominal cultures as either a monomicrobial or polymicrobial isolate were compared by univariate analysis. A multivariable logistic regression was performed to identify independent predictors of MRSA IAI. Results: Of 2,591 patients with an IAI, 240 patients had a nasal MRSA screen within 30d prior to infection and abdominal culture data, with an incidence of 23% for MRSA IAI. Patients with MRSA IAI (n=45) had more healthcare associated infections, lower white blood cell counts and greater rates of positive nasal MRSA screenings compared with those with non-MRSA IAI. By multivariable analysis (C statistic=0.908), the strongest independent predictor of an MRSA IAI was a positive MRSA screen (odds ratio [OR] 40.9, confidence interval [CI] 14.2-118.1). The positive predictive value for a MRSA screen was 53% whereas the negative predictive value of a MRSA screen was 97%. Conclusion: A negative MRSA nasal screen indicates with near certainty the absence of MRSA as part of an IAI. In the setting of a recent screen, empiric vancomycin can be withheld. Further, rapid MRSA nasal screening could be used to forego or to discontinue vancomycin therapy rapidly in the setting of IAI. This change in empiric antibiotic management of IAI may lead to decreased morbidity, reduction in cost, and a decrease in bacterial resistance.

Original languageEnglish (US)
Pages (from-to)396-400
Number of pages5
JournalSurgical Infections
Volume16
Issue number4
DOIs
StatePublished - Aug 1 2015

Fingerprint

Intraabdominal Infections
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Nose
Infection
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Can Nasal Methicillin-Resistant Staphylococcus aureus Screening Be Used to Avoid Empiric Vancomycin Use in Intra-Abdominal Infection? / Hennessy, Sara A.; Shah, Puja M.; Guidry, Christopher A.; Davies, Stephen W.; Hranjec, Tjasa; Sawyer, Robert G.

In: Surgical Infections, Vol. 16, No. 4, 01.08.2015, p. 396-400.

Research output: Contribution to journalArticle

Hennessy, Sara A. ; Shah, Puja M. ; Guidry, Christopher A. ; Davies, Stephen W. ; Hranjec, Tjasa ; Sawyer, Robert G. / Can Nasal Methicillin-Resistant Staphylococcus aureus Screening Be Used to Avoid Empiric Vancomycin Use in Intra-Abdominal Infection?. In: Surgical Infections. 2015 ; Vol. 16, No. 4. pp. 396-400.
@article{e3c9a0996f7b4b0189f152e85f4da44c,
title = "Can Nasal Methicillin-Resistant Staphylococcus aureus Screening Be Used to Avoid Empiric Vancomycin Use in Intra-Abdominal Infection?",
abstract = "Background: Vancomycin is used widely as empiric therapy for gram-positive organisms in patients with an intra-abdominal infection (IAI), even in those with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. Potential adverse effects of vancomycin include nephrotoxicity, increased cost, and bacterial resistance. We hypothesized that MRSA nasal screening could be used to predict patients with a MRSA IAI and used to avoid unnecessary empiric vancomycin use. Methods: A surgical infections database collected prospectively from a single institution was reviewed for all IAIs between January 1, 2000-December 31, 2011. Patients with and without MRSA obtained from abdominal cultures as either a monomicrobial or polymicrobial isolate were compared by univariate analysis. A multivariable logistic regression was performed to identify independent predictors of MRSA IAI. Results: Of 2,591 patients with an IAI, 240 patients had a nasal MRSA screen within 30d prior to infection and abdominal culture data, with an incidence of 23{\%} for MRSA IAI. Patients with MRSA IAI (n=45) had more healthcare associated infections, lower white blood cell counts and greater rates of positive nasal MRSA screenings compared with those with non-MRSA IAI. By multivariable analysis (C statistic=0.908), the strongest independent predictor of an MRSA IAI was a positive MRSA screen (odds ratio [OR] 40.9, confidence interval [CI] 14.2-118.1). The positive predictive value for a MRSA screen was 53{\%} whereas the negative predictive value of a MRSA screen was 97{\%}. Conclusion: A negative MRSA nasal screen indicates with near certainty the absence of MRSA as part of an IAI. In the setting of a recent screen, empiric vancomycin can be withheld. Further, rapid MRSA nasal screening could be used to forego or to discontinue vancomycin therapy rapidly in the setting of IAI. This change in empiric antibiotic management of IAI may lead to decreased morbidity, reduction in cost, and a decrease in bacterial resistance.",
author = "Hennessy, {Sara A.} and Shah, {Puja M.} and Guidry, {Christopher A.} and Davies, {Stephen W.} and Tjasa Hranjec and Sawyer, {Robert G.}",
year = "2015",
month = "8",
day = "1",
doi = "10.1089/sur.2014.211",
language = "English (US)",
volume = "16",
pages = "396--400",
journal = "Surgical Infections",
issn = "1096-2964",
publisher = "Mary Ann Liebert Inc.",
number = "4",

}

TY - JOUR

T1 - Can Nasal Methicillin-Resistant Staphylococcus aureus Screening Be Used to Avoid Empiric Vancomycin Use in Intra-Abdominal Infection?

AU - Hennessy, Sara A.

AU - Shah, Puja M.

AU - Guidry, Christopher A.

AU - Davies, Stephen W.

AU - Hranjec, Tjasa

AU - Sawyer, Robert G.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background: Vancomycin is used widely as empiric therapy for gram-positive organisms in patients with an intra-abdominal infection (IAI), even in those with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. Potential adverse effects of vancomycin include nephrotoxicity, increased cost, and bacterial resistance. We hypothesized that MRSA nasal screening could be used to predict patients with a MRSA IAI and used to avoid unnecessary empiric vancomycin use. Methods: A surgical infections database collected prospectively from a single institution was reviewed for all IAIs between January 1, 2000-December 31, 2011. Patients with and without MRSA obtained from abdominal cultures as either a monomicrobial or polymicrobial isolate were compared by univariate analysis. A multivariable logistic regression was performed to identify independent predictors of MRSA IAI. Results: Of 2,591 patients with an IAI, 240 patients had a nasal MRSA screen within 30d prior to infection and abdominal culture data, with an incidence of 23% for MRSA IAI. Patients with MRSA IAI (n=45) had more healthcare associated infections, lower white blood cell counts and greater rates of positive nasal MRSA screenings compared with those with non-MRSA IAI. By multivariable analysis (C statistic=0.908), the strongest independent predictor of an MRSA IAI was a positive MRSA screen (odds ratio [OR] 40.9, confidence interval [CI] 14.2-118.1). The positive predictive value for a MRSA screen was 53% whereas the negative predictive value of a MRSA screen was 97%. Conclusion: A negative MRSA nasal screen indicates with near certainty the absence of MRSA as part of an IAI. In the setting of a recent screen, empiric vancomycin can be withheld. Further, rapid MRSA nasal screening could be used to forego or to discontinue vancomycin therapy rapidly in the setting of IAI. This change in empiric antibiotic management of IAI may lead to decreased morbidity, reduction in cost, and a decrease in bacterial resistance.

AB - Background: Vancomycin is used widely as empiric therapy for gram-positive organisms in patients with an intra-abdominal infection (IAI), even in those with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. Potential adverse effects of vancomycin include nephrotoxicity, increased cost, and bacterial resistance. We hypothesized that MRSA nasal screening could be used to predict patients with a MRSA IAI and used to avoid unnecessary empiric vancomycin use. Methods: A surgical infections database collected prospectively from a single institution was reviewed for all IAIs between January 1, 2000-December 31, 2011. Patients with and without MRSA obtained from abdominal cultures as either a monomicrobial or polymicrobial isolate were compared by univariate analysis. A multivariable logistic regression was performed to identify independent predictors of MRSA IAI. Results: Of 2,591 patients with an IAI, 240 patients had a nasal MRSA screen within 30d prior to infection and abdominal culture data, with an incidence of 23% for MRSA IAI. Patients with MRSA IAI (n=45) had more healthcare associated infections, lower white blood cell counts and greater rates of positive nasal MRSA screenings compared with those with non-MRSA IAI. By multivariable analysis (C statistic=0.908), the strongest independent predictor of an MRSA IAI was a positive MRSA screen (odds ratio [OR] 40.9, confidence interval [CI] 14.2-118.1). The positive predictive value for a MRSA screen was 53% whereas the negative predictive value of a MRSA screen was 97%. Conclusion: A negative MRSA nasal screen indicates with near certainty the absence of MRSA as part of an IAI. In the setting of a recent screen, empiric vancomycin can be withheld. Further, rapid MRSA nasal screening could be used to forego or to discontinue vancomycin therapy rapidly in the setting of IAI. This change in empiric antibiotic management of IAI may lead to decreased morbidity, reduction in cost, and a decrease in bacterial resistance.

UR - http://www.scopus.com/inward/record.url?scp=84937905938&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937905938&partnerID=8YFLogxK

U2 - 10.1089/sur.2014.211

DO - 10.1089/sur.2014.211

M3 - Article

C2 - 26069990

AN - SCOPUS:84937905938

VL - 16

SP - 396

EP - 400

JO - Surgical Infections

JF - Surgical Infections

SN - 1096-2964

IS - 4

ER -