scholarly journals 2683. Evaluation of the Negative Predictive Value (NPV) of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Swab Screening in Acute Myeloid Leukemia Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S942-S943
Author(s):  
Bailee Binks ◽  
Dayna McManus ◽  
Sarah Perreault ◽  
Jeffrey E Topal
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Myeloid Leukemia ◽  
Antibiotic Therapy ◽  
Predictive Value ◽  
Myeloid Leukemia ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Nasal Swabs ◽  
Mrsa Infection ◽  
Acute Myeloid

Abstract Background Methicillin-Resistant Staphylococcus aureus (MRSA) nasal swabs are utilized to guide discontinuation of empiric MRSA therapy. In multiple studies, MRSA nasal swabs has been shown to have a negative predictive value (NPV) of ~99% in non-oncology patients with pneumonia and other infections. At Yale New Haven Hospital (YNHH), a negative MRSA nasal swab is utilized in acute myeloid leukemia (AML) patients to de-escalate empiric MRSA antibiotic therapy. The primary endpoint was to assess the percentage of patients with a negative MRSA nasal swab who developed a culture documented (CD) MRSA infection during their admission. Secondary endpoints included the number of MRSA nasal swabs that were initially negative but converted to positive, and the types of MRSA infections. Methods This was a retrospective chart review of AML patients with a suspected infection and a MRSA nasal swab collected at YNHH between 2013 and 2018. Patients were excluded if < 18 years old, prior confirmed MRSA infection or positive MRSA nasal swab within the past year. Results 194 patients were identified with 484 discrete encounters analyzed. Hematopoietic stem cell transplantation occurred in 83 (43%) patients. A total of 468 (97%) encounters had a negative MRSA nasal swab upon admission with no CD MRSA infection during their hospitalization. Three encounters (0.6%) had a negative MRSA nasal swab with a subsequent CD MRSA infection during their admission. Identified infections were bacteremia (2) and pneumonia (1). Median duration from the negative MRSA nasal swab to CD infection was 16 days. Thirteen encounters (3%) had a positive MRSA nasal swab, 5 of which had a CD MRSA infection. Infections included bacteremia (3), pneumonia (2), and sputum with negative chest X-ray (1). MRSA nasal swab had a sensitivity of 57% (CI 0.56–0.58), specificity of 98% (CI 0.98–0.98) positive predictive value of 31% (CI 0.3–0.32), and NPV of 99% (CI 0.99–0.99). Conclusion The results of this retrospective study demonstrate that a negative MRSA nasal swab has a 99% NPV for subsequent MRSA infections in AML patients with no prior history of MRSA colonization or infection. Based on these findings, a negative MRSA nasal swab can help guide de-escalation of empiric MRSA antibiotic therapy in this immunosuppressed population. Disclosures All authors: No reported disclosures.

Evaluation of the negative predictive value of methicillin-resistant Staphylococcus aureus nasal swab screening in patients with acute myeloid leukemia

2020 ◽  
pp. 1-4
Author(s):  
Sarah K. Perreault ◽  
Bailee Binks ◽  
Dayna S. McManus ◽  
Jeffrey E. Topal
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Myeloid Leukemia ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Myeloid Leukemia ◽  
Nasal Swab ◽  
Nasal Swabs ◽  
Mrsa Infection ◽  
Acute Myeloid

Abstract Objective: Methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs are utilized to guide the discontinuation of empiric MRSA therapy. In multiple studies, MRSA nasal swabs have been shown to have a negative predictive value (NPV) of ~99% in non-oncology patients with pneumonia and other infections. We evaluated the performance characteristics of a negative MRSA nasal swab in the acute myeloid leukemia (AML) populaion to determine its NPV. Design: Retrospective chart review. Patients: This study included adult AML patients with a suspected infection and a MRSA nasal swab collected between 2013 and 2018. Methods: MRSA nasal swab and culture-documented infections were identified to determine the sensitivity, specificity, NPV, and positive predictive value of the MRSA nasal swabs. Results: In total, 194 patients were identified, and 484 discrete encounters were analyzed. Overall, 468 (97%) encounters had a negative MRSA nasal swab upon admission with no cultured documented MRSA infection during their hospitalization. However, 3 encounters (0.6%) had a negative MRSA nasal swab with a subsequent cultured documented MRSA infection during their admission. Identified infections were bacteremia (n = 2) and confirmed pneumonia (n = 1). MRSA nasal swab had a sensitivity of 62% (95% CI, 0.24–0.91), specificity of 98% (95% CI, 0.96–0.99), positive predictive value of 38% (95% CI, 0.21–0.6), and NPV of 99% (95% CI, 0.98–1). Conclusions: A negative MRSA nasal swab has a 99% NPV for subsequent MRSA infections in AML patients with no prior history of MRSA colonization or infection. Based on these findings, a negative MRSA nasal swab can help guide de-escalation of empiric MRSA antibiotic therapy.

scholarly journals Screening for Methicillin-Resistant Staphylococcus aureus Colonization Using Sponges

2015 ◽  
Vol 36 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Chang-Seop Lee ◽  
Bianca Montalmont ◽  
Jessica A. O’Hara ◽  
Alveena Syed ◽  
Charma Chaussard ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Type Ii ◽  
Chain Reaction ◽  
Methicillin Resistant ◽  
Nasal Swabs ◽  
Positive Specimen ◽  
Mrsa Infection ◽  
Polymerase Chain

OBJECTIVENasal swab culture is the standard method for identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers. However, this method is known to miss a substantial portion of those carrying MRSA elsewhere. We hypothesized that the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection.DESIGNHospitalized patients with recent MRSA infection were enrolled and underwent MRSA screening of the forehead, nostrils, pharynx, axilla, and groin with separate swabs and the forehead, axilla, and groin with separate sponges. Staphylococcal cassette chromosome mec (SCCmec) typing was conducted by polymerase chain reaction (PCR).PATIENTSA total of 105 MRSA patients were included in the study.RESULTSAt least 1 specimen from 56.2% of the patients grew MRSA. Among patients with at least 1 positive specimen, the detection sensitivities were 79.7% for the swabs and 64.4% for the sponges. Notably, 86.4% were detected by a combination of sponges and nasal swab, and 72.9% were detected by a combination of pharyngeal and nasal swabs, whereas only 50.9% were detected by nasal swab alone (P<0.0001 and P=0.0003, respectively). Most isolates had SCCmec type II (59.9%) and IV (35.7%). No correlation was observed between the SCCmec types and collection sites.CONCLUSIONScreening using a sponge significantly improves MRSA detection when used in addition to screening with the standard nasal swab.Infect Control Hosp Epidemiol 2014;36(1): 28–33

Predictive value of molecular remissions postconsolidation chemotherapy in patients with Core Binding Factor Acute Myeloid Leukemia (CBF-AML) - a single center analysis

2016 ◽  
Vol 35 (4) ◽  
pp. 810-813 ◽  
Author(s):  
Uday Deotare ◽  
Marwan Shaheen ◽  
Joseph M. Brandwein ◽  
Bethany Pitcher ◽  
Suzanne Kamel-Reid ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Predictive Value ◽  
Myeloid Leukemia ◽  
Single Center ◽  
Core Binding Factor ◽  
Binding Factor ◽  
Acute Myeloid

scholarly journals Pretreatment platelet count predicts survival outcome of patients with de novo non-M3 acute myeloid leukemia

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e4139 ◽  
Author(s):  
Qianying Zhang ◽  
Kanchun Dai ◽  
Laixi Bi ◽  
Songfu Jiang ◽  
Yixiang Han ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Platelet Count ◽  
Predictive Value ◽  
Myeloid Leukemia ◽  
De Novo ◽  
Univariate Analysis ◽  
Survival Outcome ◽  
Cox Regression Analysis ◽  
High Platelet Count ◽  
Acute Myeloid

Background Pretreatment platelet count has been reported as a potential tool to predict survival outcome in several solid tumors. However, the predictive value of pretreatment platelet count remains obscure in de novo acute myeloid leukemia (AML) excluding acute promyelocytic leukemia (M3). Methods We conducted a retrospective review of 209 patients with de novo non-M3 AML in our institute over a period of 8 years (2007–2015). Receiver operating characteristic (ROC) curve analysis was used to determine the optimal platelet (PLT) cutoff in patients. We analyzed the overall survival (OS) and disease free survival (DFS) using the log-rank test and Cox regression analysis. Results By defining the platelet count 50 × 109/L and 120 × 109/L as two cut-off points, we categorized the patients into three groups: low (<50 × 109/L), medium (50–120 × 109/L) and high (>120 × 109/L). On univariate analysis, patients with medium platelet count had longer OS and DFS than those with low or high platelet count. However, the multivariate analysis showed that only longer DFS was observed in patients with medium platelet count than those with low or high platelet count. Conclusion Our findings indicate that pretreatment platelet count has a predictive value for the prognosis of patients with non-M3 AML.

Correlation Between Patients With Methicillin-Resistant Staphylococcus aureus (MRSA) Nares Colonization and MRSA Diabetic Foot Infections

2020 ◽  
pp. 153473462096357
Author(s):  
Jacquelyn Brondo ◽  
Kathleen Morneau ◽  
Teri Hopkins ◽  
Linda Yang ◽  
Jose Cadena-Zuluaga ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Predictive Value ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Empiric Therapy ◽  
Inclusion Criteria ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections ◽  
Prior Literature ◽  
Mrsa Infection

Infectious Diseases Society of America diabetic foot infection (DFI) guidelines indicate empiric methicillin-resistant Staphylococcus aureus (MRSA) coverage for patients with a history of MRSA infection, when local prevalence of MRSA is high, or infection is clinically severe. These recommendations may lead to overutilization of empiric MRSA coverage, which can result in serious consequences. A strong negative predictive value (NPV) has been reported in literature for pneumonia, and recently, for all anatomical sites of infection. While these findings are promising, further validation is needed before clinicians may confidently use MRSA nares to guide empiric therapy for DFIs. A retrospective electronic medical record review was completed between October 1, 2013 and October 1, 2019. Patients met inclusion criteria if they were at least 18, admitted with a DFI, had MRSA nares test results, and DFI cultures. Patients were excluded if pregnant or MRSA infection within 1 year prior to index admission for DFI. A total of 200 patients met inclusion criteria. The majority of study participants were male with a mean age of 63. NPV of MRSA nares for MRSA DFIs was determined to be 94% and positive predictive value 58%. Sensitivity and specificity were 56% and 94%, respectively. Results of this study are consistent with prior literature supporting strong correlation of NPV for MRSA nares. The DFIs evaluated suggest a strong NPV of MRSA nares for MRSA DFIs, which may allow for faster de-escalation of empiric anti-MRSA antibiotic therapy and lower risk of adverse events associated with anti-MRSA therapy.

Acute myeloid leukemia: lack of predictive value of sequential quantitative MR imaging during treatment.

Radiology ◽  
1995 ◽  
Vol 197 (1) ◽  
pp. 301-305 ◽  
Author(s):  
B C Vande Berg ◽  
P J Schmitz ◽  
J M Scheiff ◽  
B J Filleul ◽  
J L Michaux ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Mr Imaging ◽  
Predictive Value ◽  
Myeloid Leukemia ◽  
Quantitative Mr Imaging ◽  
Quantitative Mr ◽  
Acute Myeloid
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