Pediatric Clinical Outcomes of Nasal Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Utilization.

IF 2.9 4区 医学 Q3 IMMUNOLOGY
Salih Demirhan, Kevin Burgos, Kiriam Escobar Lee, Philip Lee, Sharlene Sy, Betsy C Herold, Brenda I Anosike
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Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a clinical challenge in selecting empiric antimicrobials for pediatric infections. We implemented nasal MRSA polymerase chain reaction (nMRSA PCR) screening as a diagnostic tool and evaluated its impact on empiric antibiotic use and clinical outcomes.

Methods: A retrospective single-center study of patients hospitalized with infections who were empirically prescribed anti-MRSA antibiotics was conducted prior to and following the initiation of nMRSA PCR screening. Electronic medical records, pharmacy data and bacterial cultures results were reviewed. Predictive values of nMRSA PCR testing were calculated and the duration of anti-MRSA empiric therapy and clinical outcomes preimplementation and postimplementation were compared.

Results: During the preimplementation period, there were 382 distinct episodes (294 unique patients) that met the inclusion criteria and during post-nMRSA PCR implementation, 394 episodes (360 unique patients) were identified. The median time to discontinuation of anti-MRSA antibiotics and proportion of patients prescribed anti-MRSA antibiotics at discharge were significantly lower in postimplementation compared with preimplementation period; 48 versus 56 hours, P < 0.001 and 20.1% versus 40.3%, P < 0.001, respectively. The negative and positive predictive values of nMRSA PCR compared to clinical culture results were 95.6% and 51.2%, respectively. Predefined adverse outcomes were documented in 11 patients who had early anti-MRSA discontinuation with negative nMRSA PCR results but only 3 were restarted on anti-MRSA treatment and none grew MRSA in clinical cultures.

Conclusions: Shortened anti-MRSA antibiotic duration, high negative predictive value and low adverse events provide promising evidence that nMRSA PCR is an effective, rapid antimicrobial stewardship tool for hospitalized children.

使用鼻腔耐甲氧西林金黄色葡萄球菌聚合酶链反应的儿科临床结果。
背景:耐甲氧西林金黄色葡萄球菌(MRSA)是儿科感染选择经验性抗菌药物的临床难题。我们采用鼻腔 MRSA 聚合酶链反应(nMRSA PCR)筛查作为诊断工具,并评估其对经验性抗生素使用和临床结果的影响:对住院感染患者在 nMRSA PCR 筛查启动前后经验性使用抗 MRSA 抗生素的情况进行了单中心回顾性研究。研究人员查阅了电子病历、药房数据和细菌培养结果。计算了 nMRSA PCR 检测的预测值,并比较了实施前和实施后抗 MRSA 经验性治疗的持续时间和临床结果:在nMRSA PCR实施前,符合纳入标准的病例有382例(294名患者);在nMRSA PCR实施后,符合纳入标准的病例有394例(360名患者)。与实施前相比,实施后停用抗 MRSA 抗生素的中位时间和出院时开具抗 MRSA 抗生素处方的患者比例明显降低;分别为 48 小时对 56 小时,P < 0.001;20.1% 对 40.3%,P < 0.001。与临床培养结果相比,nMRSA PCR 的阴性和阳性预测值分别为 95.6% 和 51.2%。11 名患者因 nMRSA PCR 结果阴性而提前停止抗 MRSA 治疗,但只有 3 名患者重新开始接受抗 MRSA 治疗,且临床培养中均未发现 MRSA 生长:结论:抗 MRSA 抗生素疗程短、阴性预测值高、不良反应少,这些都有力地证明了 nMRSA PCR 是一种有效、快速的住院儿童抗菌药物管理工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.30
自引率
2.80%
发文量
566
审稿时长
2-4 weeks
期刊介绍: ​​The Pediatric Infectious Disease Journal® (PIDJ) is a complete, up-to-the-minute resource on infectious diseases in children. Through a mix of original studies, informative review articles, and unique case reports, PIDJ delivers the latest insights on combating disease in children — from state-of-the-art diagnostic techniques to the most effective drug therapies and other treatment protocols. It is a resource that can improve patient care and stimulate your personal research.
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