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Nasal swabs could reduce needless vancomycin therapy in ICU
Recent study findings suggest that using nasal surveillance swabs to test patients for MRSA could reduce unnecessary vancomycin therapy in the ICU, improving antibiotic stewardship.
According to Darunee Chotiprasitsakul, MD, MPH, of the Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, and colleagues, current guidelines recommend using empiric vancomycin to cover MRSA “for ill-appearing patients with a known history of MRSA colonization or infection, recent antibiotic exposure, complicated skin and soft-tissue infections, or recent hospitalizations.” But studies have shown that vancomycin is overused, and Chotiprasitsakul and colleagues said efforts are needed to improve prescribing practices.
“This is particularly important because vancomycin use is associated with subsequent isolation of drug-resistant organisms, including vancomycin-resistant Enterococcus and vancomycin-intermediate or resistant Staphylococcus aureus, and with adverse drug events, most notably nephrotoxicity,” they wrote in Infection Control and Hospital Epidemiology.
Chotiprasitsakul and colleagues conducted a retrospective cohort study among ICU patients at Johns Hopkins Hospital in Baltimore to determine the role of MRSA nasal swabs in prescribing vancomycin by calculating the negative predictive value (NPV) of a MRSA-negative nasal swab. The hospital performs MRSA nasal swabs on ICU patients when they are admitted and every week until they are discharged.
Among 11,441 patients included in the study from December 2013 through June 2015 who had a MRSA-negative nasal swab, just 0.22% subsequently developed MRSA — an NPV of greater than 99%, Chotiprasitsakul and colleagues reported. But approximately 36% of 11,392 patients who had negative nasal swabs and no evidence of subsequent MRSA infection received vancomycin, either upon admission or later during their ICU stay.
“For institutions that obtain MRSA nasal swabs as part of infection control practices and have a low prevalence of MRSA transmission, negative MRSA nasal swabs can be used to identify ICU patients with a low risk of MRSA infection in whom initial empiric vancomycin can be stopped and in whom subsequent empiric vancomycin starts can be avoided,” the researchers concluded. – by Gerard Gallagher
Disclosures: The authors report no relevant financial disclosures.