1 / 13

Role of MRSA Swabs for De-escalation of Antibiotics in HCAP

Role of MRSA Swabs for De-escalation of Antibiotics in HCAP. Colleen Linsenmayer, Pharm.D . PGY2 Internal Medicine Pharmacy Resident Richard L. Roudebush VA Medical Center. This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.

rosamund-jeremiah
Download Presentation

Role of MRSA Swabs for De-escalation of Antibiotics in HCAP

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Role of MRSA Swabs for De-escalation of Antibiotics in HCAP Colleen Linsenmayer, Pharm.D. PGY2 Internal Medicine Pharmacy Resident Richard L. Roudebush VA Medical Center This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation

  2. Methicillin-resistant Staphylococcus aureus (MRSA) • Increasingly important pathogen in pulmonary infections • Incidence of MRSA healthcare-associated pneumonia (HCAP) is predicted to be 2-26.5%. • Associated with significant morbidity and mortality Niederman MS et al. Am J RespirCrit Care Med. 2005;171:388-416. Dangerfield B et al. Antimicrobial Agents Chemother. 2014;58(2):859-62.

  3. IDSA HAP Guidelines Niederman MS et al. Am J RespirCrit Care Med. 2005;171:388-416.

  4. IDSA HAP Guidelines Consider de-escalation of antibiotic based on: • Results of lower respiratory tract cultures are available • Patient’s clinical response Niederman MS et al. Am J RespirCrit Care Med. 2005;171:388-416.

  5. MRSA Colonization • Identifying patients with MRSA colonization may guide initial antibiotic treatment and isolation measures • MRSA swabbing is a standard method for screening in many facilities for MRSA screening Dangerfield B et al. Antimicrobial Agents Chemother. 2014;58(2):859-62.

  6. MRSA Nasal Colonization • MRSA nasal colonization can be reliably detected using nasal swab PCR test • Presence of MRSA nasal colonization has been correlated with the development of subsequent MRSA infections Dangerfield B et al. Antimicrobial Agents Chemother. 2014;58(2):859-62. Boyce JM et al. Antimicrobial Agents Chemother. 2013;57(3):1163-8.

  7. Predictive Value of MRSA Nasal Swabs for MRSA Pneumonia Dangerfield B et al. Antimicrobial Agents Chemother. 2014;58(2):859-62

  8. MRSA Nasal Swabs - Negative Predictive Value (NPV) Harris AD et al. Antimicrobial Agents Chemother. 2010;54(8):3143-8. Robicsek A, et al. J ClinMicrobiol. 2008 ;46(2):588-92. Sarikonda KV, et al. Crit Care Med. 2010;38(10):1991-5.

  9. Discontinuation of Empiric Vancomycin Boyce JM et al. Antimicrobial Agents Chemother. 2013;57(3):1163-8.

  10. Debunking Myths “The patient’s nasal swab may be negative because they received empiric vancomycin therapy prior to the admission nasal swab” Vancomycin has been shown to have little effect on staphylococcus aureus nasal colonization and seldom would eradicate MRSA in the first several days of therapy Boyce JM et al. Antimicrobial Agents Chemother. 2013;57(3):1163-8.

  11. Clinical Pearl

  12. Summary • MRSA pneumonia is unlikely in patients who are not colonized and have no evidence of MRSA bacteremia • Data suggests that MRSA PCR nasal swabs have negative predictive value of up to 99% for MRSA pneumonia • A negative MRSA swab can be reasonably used to guide antibiotic de-escalation for HCAP

  13. Role of MRSA Swabs for De-escalation of Antibiotics in HCAP Colleen Linsenmayer, Pharm.D. PGY2 Internal Medicine Pharmacy Resident Richard L. Roudebush VA Medical Center

More Related