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Usefulness ofPreviousMethicillin-resistantStaphylococcusaureusScreeningResults in GuidingEmpirical TherapyforS AureusBacteremia Anthony D. BaiLisa BurryAdrienne Showler2015 год

Usefulness of Previous Methicillin-resistantStaphylococcus aureusScreening Results in Guiding Empirical Therapy forS AureusBacteremia
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Аннотация: BACKGROUND: Staphylococcus aureus bacteremia (SAB) is an important infection. Methicillin‐resistant S aureus (MRSA) screening is performed on hospitalized patients for infection control purposes. OBJECTIVE: To assess the usefulness of past MRSA screening for guiding empirical antibiotic therapy for SAB. METHODS: A retrospective cohort study examined consecutive patients with confirmed SAB and previous MRSA screening swab from six academic and community hospitals between 2007 and 2010. Diagnostic test properties were calculated for MRSA screening swab for predicting methicillin resistance of SAB. RESULTS: A total of 799 patients underwent MRSA screening swabs before SAB. Of the 799 patients, 95 (12%) had a positive and 704 (88%) had a negative previous MRSA screening swab. There were 150 (19%) patients with MRSA bacteremia. Overall, previous MRSA screening swabs had a positive likelihood ratio of 33 (95% CI 18 to 60) and a negative likelihood ratio of 0.45 (95% CI 0.37 to 0.54). Diagnostic accuracy differed depending on mode of acquisition (ie, community‐acquired, nosocomial or health care‐associated infection) (P<0.0001) and hospital (P=0.0002). At best, for health care‐associated infection, prior MRSA screening swab had a positive likelihood ratio of 16 (95% CI 9 to 28) and a negative likelihood ratio of 0.27 (95% CI 0.17 to 0.41). CONCLUSIONS: A negative prior MRSA screening swab cannot reliably rule out MRSA bacteremia and should not be used to guide empirical antibiotic therapy for SAB. A positive prior MRSA screening swab greatly increases likelihood of MRSA, necessitating MRSA coverage in empirical antibiotic therapy for SAB.
Год издания: 2015
Авторы: Anthony D. Bai, Lisa Burry, Adrienne Showler, Marilyn Steinberg, Daniel Ricciuto, Tânia Fernandes, Anna Chiu, Sumit Raybardhan, George Tomlinson, Chaim M. Bell, Andrew M. Morris
Издательство: Pulsus Group
Источник: Canadian Journal of Infectious Diseases and Medical Microbiology
Ключевые слова: Antimicrobial Resistance in Staphylococcus, Bacterial Identification and Susceptibility Testing, Streptococcal Infections and Treatments
Другие ссылки: Canadian Journal of Infectious Diseases and Medical Microbiology (PDF)
Canadian Journal of Infectious Diseases and Medical Microbiology (HTML)
Europe PMC (PubMed Central) (PDF)
Europe PMC (PubMed Central) (HTML)
PubMed Central (HTML)
TSpace (University of Toronto) (PDF)
TSpace (University of Toronto) (HTML)
PubMed (HTML)