Impact of a Methicillin-Resistant Staphylococcus Aureus Active Surveillance Culture Protocol on Mupirocin Prescribing

2009 ◽  
Vol 44 (9) ◽  
pp. 781-784
Author(s):  
Marisel Segarra-Newnham ◽  
Kristin St. John
Keyword(s):  
Staphylococcus Aureus ◽  
Active Surveillance ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Inpatient Setting ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
The Impact ◽  
Active Surveillance Culture

Background To identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), an active surveillance culture (ASC) protocol has been in place since March 2007. Decolonization with mupirocin ointment is not recommended but may be attempted after a positive MRSA screen. Objective Assess the impact of an inpatient ASC protocol on prescribing of mupirocin nasal ointment for decolonization before and after protocol implementation. Methods A retrospective review of mupirocin inpatient prescribing and outpatient clinic requests from March 2006 through February 2007 (1 year before ASC implementation) and from March 2007 through February 2008 (1 year after ASC implementation) was conducted. Cultures for MRSA after decolonization were evaluated. Results During the 24 months reviewed, 38 inpatients received mupirocin (18 before and 20 after ASC). Only 14 patients (37%) had a follow-up nasal swab (5 before and 9 after ASC). Of these patients, 5 (36%) had a positive nasal swab after the initial decolonization attempt. Ten patients (26%) had at least 1 clinical culture positive for MRSA after the initial decolonization (7 before and 3 after ASC). Outpatient requests for mupirocin increased 2.5-fold after ASC implementation. Sixty percent of the requests were not appropriate. Conclusion After implementation of the ASC protocol, there was no change in mupirocin prescribing for decolonization in the inpatient setting. However, outpatient requests—most of which were not indicated—increased. Success of decolonization cannot be assessed because follow-up nasal screening was not universally performed.

Active Surveillance for Methicillin-Resistant Staphylococcus aureus(MRSA) Decreases the Incidence of MRSA Bacteremia

2006 ◽  
Vol 27 (10) ◽  
pp. 1004-1008 ◽  
Author(s):  
Pnina Shitrit ◽  
Bat-Sheva Gottesman ◽  
Michal Katzir ◽  
Avi Kilman ◽  
Yona Ben-Nissan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
High Risk ◽  
Active Surveillance ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
Contact Isolation ◽  
Surveillance Cultures ◽  
The Mean ◽  
Positive Results

Objectives.To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital.Design.Before-after trial.Setting.A 700-bed hospital.Patients.All patients admitted to the hospital who were at high risk for MRSA bacteremia.Intervention.Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004).Results.The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (P<.001). The mean number of MRSA bacteremia cases per month decreased from 3.6 cases before the intervention to 1.8 cases after the intervention (P< 0.001).Conclusions.Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.

scholarly journals Effectiveness of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for Reduction of Vancomycin Use for Pneumonia

2020 ◽  
Vol 41 (S1) ◽  
pp. s470-s471
Author(s):  
Shannon Snellgrove ◽  
Matthew Brown ◽  
Seth Edwards ◽  
Sixto Leal ◽  
Allen Bryan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Screening Tool ◽  
Hemodynamic Instability ◽  
Exclusion Criteria ◽  
Methicillin Resistant ◽  
Screening Questionnaire ◽  
Days Of Therapy ◽  
Antibiotic Coverage

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been a well-established risk for developing MRSA pneumonia. In previous studies, the MRSA nasal screening test has shown an excellent negative predictive value (NPV) for MRSA pneumonia in patients without exclusion criteria such as mechanical ventilation, hemodynamic instability, cavitary lesions, and underlying pulmonary disease. MRSA nasal screening can be used as a stewardship tool to de-escalate broad antibiotic coverage, such as vancomycin. Objective: The purpose of this study was to determine whether implementation of a MRSA nasal screening questionnaire improves de-escalation of vancomycin for patients with pneumonia. Methods: A retrospective review was performed on 250 patients from October 2018 to January 2019 who received MRSA nasal screening due to their prescriber choosing only “respiratory” on the vancomycin dosing consult form. Data obtained included demographics and clinical outcomes. Statistical analyses were performed, and P < .05 was considered significant. Results: Of the 250 patients screened, only 19 patients (8%) were positive for MRSA. Moreover, 40% of patients met exclusion criteria. In 149 patients without exclusion criteria, the MRSA nasal swab had a 98% NPV. Although not statistically significant, vancomycin days of therapy (DOT) based on MRSA nasal swab result was 1 day shorter in those with negative swabs (3.49 days negative vs 4.58 days positive; P = .22). Vancomycin DOT was significantly reduced in pneumonia patients without exclusion criteria (3.17 days “no” vs 4.17 days “yes”; P = .037). Conclusions: The implementation of an electronic MRSA nasal screening questionnaire resulted in reduced vancomycin DOT in pneumonia patients at UAB Hospital. The MRSA nasal swab is an effective screening tool for antibiotic de-escalation based on its 98% NPV for MRSA pneumonia if utilized in the correct patient population.Funding: NoneDisclosures: Rachael Anne Lee reports a speaker honoraria from Prime Education, LLC.

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