Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is frequently targeted with empiric treatment for pneumonia in the hospital. Obtaining quality lower respiratory tract cultures to promote appropriate de-escalation can be difficult or impractical. Nasal screening for MRSA has a high negative predictive value for MRSA pneumonia and can be an effective tool for early de-escalation. Methods: A pharmacist-driven process for nasopharyngeal MRSA screening of patients prescribed intravenous vancomycin was implemented in October 2018. Vancomycin utilization was extracted from the electronic medical record (EMR) and summarized as days of therapy per 1,000 patient days (DOT/1,000 PD). Vancomycin utilization data for the 6 months following process implementation (November 2018–April 2019) were compared to the same period from the previous year (November 2017–April 2018). Specific patient outcomes data were manually collected for patients prescribed vancomycin for pneumonia during the first 2 months following process implementation (November–December 2018; postintervention group) and comparable months (November–December 2017; preintervention group). Data were analyzed using the 2 test (nominal data) and Mann–Whitney U test (continuous data). Results: Total vancomycin utilization decreased from a monthly average of 114 to 95 DOT/1,000 PD (17% reduction) and from 27 to 14 DOT/1,000 PD for pneumonia (48% reduction). In-patient mortality was unchanged following process implementation at 17.2% versus 17.5% in the pre- and postintervention groups, respectively. Other clinical outcomes were also similar between the pre- and postintervention groups (Table 1). Fewer vancomycin levels were obtained following implementation with 34.4% of patients (0.61 levels per patient) having a level obtained in the preintervention group compared to 21.6% (0.30 levels per patient; P .001) in the postintervention group. Conclusions: Nasopharyngeal MRSA screening of patients prescribed vancomycin for pneumonia is an effective antimicrobial stewardship strategy to reduce unnecessary use of anti-MRSA therapy without negatively impacting clinical outcomes.Funding: NoneDisclosures: None

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Use of BBL CHROMagar MRSA Medium for Identification of Methicillin-Resistant Staphylococcus aureus Directly from Blood Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.00399-06 ◽

2006 ◽

Vol 44 (7) ◽

pp. 2575-2576 ◽

Cited By ~ 16

Author(s):

J. Pape ◽

J. Wadlin ◽

I. Nachamkin

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Blood Cultures ◽

Methicillin Resistant

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Controlled Multicenter Evaluation of a Bacteriophage-Based Method for Rapid Detection of Staphylococcus aureus in Positive Blood Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.02967-12 ◽

2013 ◽

Vol 51 (4) ◽

pp. 1226-1230 ◽

Cited By ~ 32

Author(s):

T. Bhowmick ◽

S. Mirrett ◽

L. B. Reller ◽

C. Price ◽

C. Qi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Rapid Detection ◽

Blood Cultures

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Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus: Methicillin-resistant isolates are detected directly in blood cultures by multiplex PCR

Microbiological Research ◽

10.1016/j.micres.2009.03.003 ◽

2010 ◽

Vol 165 (3) ◽

pp. 243-249 ◽

Cited By ~ 28

Author(s):

Eliezer M. Pereira ◽

Ricardo P. Schuenck ◽

Karoline L. Malvar ◽

Natalia L.P. Iorio ◽

Pricilla D.M. Matos ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Multiplex Pcr ◽

Staphylococcus Epidermidis ◽

Blood Cultures ◽

Methicillin Resistant ◽

Staphylococcus Haemolyticus

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Recurrent Methicillin-Resistant Staphylococcus Aureus Osteomyelitis: Combination Antibiotic Therapy with Evaluation by Serum Bactericidal Titers

Annals of Pharmacotherapy ◽

10.1177/106002809502907-807 ◽

1995 ◽

Vol 29 (7-8) ◽

pp. 694-697 ◽

Cited By ~ 9

Author(s):

Sherrie L Aspinall ◽

David M Friedland ◽

Victor L Yu ◽

John D Rihs ◽

Robert R Muder

Keyword(s):

Staphylococcus Aureus ◽

Back Pain ◽

Antibiotic Therapy ◽

Sedimentation Rate ◽

Methicillin Resistant Staphylococcus Aureus ◽

Blood Cultures ◽

Low Back ◽

Methicillin Resistant ◽

Trough Concentrations

Objective: To report on a patient with recurrent methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bacteremia successfully treated with combination antibiotic therapy. Case Summary: Two sets of blood cultures from a 55-year-old man with fever, malaise, and low back pain grew MRSA. Radiologic studies of the spine showed bony changes consistent with osteomyelitis. Soon after completing 6 weeks of vancomycin, the patient experienced a recurrence of back pain. Laboratory values included an increase in the sedimentation rate to 53 mm/h and positive blood cultures for MRSA. Vancomycin, gentamicin, and rifampin were administered for 8 weeks. Serum inhibitory and bactericidal titers were more than 1:1024 for both the peak and trough concentrations. Radiologic studies of the spine showed healing osteomyelitis. Two years after completion of antibiotic therapy, the infection has not recurred. Discussion: Antibiotic therapy alone was attempted because the patient was considered a risky surgical candidate. Serum inhibitory and bactericidal titers documented the high in vivo activity of the vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin therapy led to disappearance of the fever and back pain. Cure was documented by sustained normalization of the erythrocyte sedimentation rate and radiologic evidence of healing. Conclusions: Combination antibiotic therapy with vancomycin, rifampin, and low-dose gentamicin (1 mg/kg q12h) may be useful for deep-seated tissue infection caused by MRSA.

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Prevalence of Staphylococcus aureus and Methicillin-resistant S. aureus in Adult Hospitalized Patients in “Mother Theresa” Hospital Center in Albania

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3565 ◽

2020 ◽

Vol 8 (A) ◽

pp. 297-302

Author(s):

Blerta Kika ◽

Erjona Abazaj ◽

Oltiana Petri ◽

Andi Koraqi

Keyword(s):

Staphylococcus Aureus ◽

Rapid Detection ◽

Latex Agglutination ◽

Hospitalized Patients ◽

Hospital Environment ◽

Drug Resistant ◽

Methicillin Resistant ◽

Clinical Specimens ◽

Microbial Identification ◽

Hospital Center

AIM: The aim of this study was to evaluate the prevalence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in clinical specimens hospitalized to “Mother Theresa” Hospital Center for 2 years. METHODS: We isolated and identified S. aureus on 356 clinical specimens using standard tests. Furthermore, for further accurate microbial identification, we have to use the VITEK® 2 system. The samples were tested to detect the presence of MRSA by a slide latex agglutination kit for the rapid detection of PBP2. RESULTS: The overall prevalence of S. aureus in patients was 34.2%. The prevalence of MRSA was 20.5% of cases. Of the MRSA isolates identified in this study, 28% were susceptible to antibiotics, 24% demonstrated intermediate resistance, and 48% were multi-drug resistant with resistance to nineteen antibiotics involved in the examination. In addition, seven of the 25 MRSA cases showed 100% resistance to norfloxacin, imipenem, meropenem, levofloxacin, etc. CONCLUSIONS: The rate of S. aureus in hospitalized patients on this study was 34.2% and the MRSA 20.5%. These results indicated that this type of infection is a significant concern for health services and patients included. A screening of all hospitalized cases can lead to reduce the incidence of this infection in the hospital environment.

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