Active identification of patients who are methicillin-resistant Staphylococcus aureus colonized is not associated with longer duration of vancomycin therapy

作者：Acuna Villaorduna Carlos; Branch Elliman Westyn; Strymish Judith; Gupta Kalpana

来源：American Journal of Infection Control, 2017, 45(10): 1081-1085.

DOI：10.1016/j.ajic.2017.04.011

• Vancomycin
• Methicillin-resistant Staphylococcus aureus
• Surveillance

Background: Excessive prescribing of vancomycin among patients admitted to inpatient wards is a challenge for antimicrobial stewardship programs, especially in the setting of expanded screening programs for methicillin-resistant Staphylococcus aureus (MRSA). Studies examining factors associated with longer duration of vancomycin use are limited.
Methods: We conducted a retrospective cohort study to assess the impact of universal MRSA admission screening on duration of vancomycin use at the VA Boston Healthcare System during the period from January 2013-November 2015.
Results: A total of 2,910 patients were administered intravenous vancomycin during the study period. A clinical culture positive for MRSA was strongly associated with vancomycin administration lasting >72 hours (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.86-3.97; P < .001). After controlling for clinical culture results, admission MRSA colonization was not associated with vancomycin use past 72 hours (OR, 0.94; 95% CI, 0.8-1.1). A negative MRSA nasal swab on admission had a high negative predictive value for all MRSA infections evaluated (99.6% for pneumonia, 99.6% for bloodstream infection, and 98.1% for skin and soft tissue infection).
Conclusions: Admission surveillance for MRSA nasal colonization is not a major driver of prolonged vancomycin use. A negative admission MRSA nasal screen may be a useful tool for antimicrobial stewardship programs to limit vancomycin use, particularly in noncritically ill patients. Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.

• 出版日期2017-10-1