This article is more than 5 years old. Information may no longer be current.
Rapid testing reduces vancomycin, linezolid use for suspected MRSA pneumonia
Click Here to Manage Email Alerts
Vancomycin and linezolid use among ventilated patients with suspected MRSA pneumonia can be significantly reduced by using a highly sensitive rapid diagnostic test on bronchoalveolar lavage fluid, researchers reported in the journal Chest.
“Empirical treatment for suspected MRSA pneumonia based on clinical risk factors still results in significant overtreatment,” Richard G. Wunderink, MD, professor of medicine in pulmonary and critical care at the Northwestern University Feinberg School of Medicine, told Infectious Disease News. “A rapid diagnostic test can decrease empirical anti-MRSA antibiotic use even compared to stopping if cultures are negative.”
Wunderink and colleagues conducted a prospective, unblinded, randomized clinical trial to compare rapid diagnostic testing (RDT) with usual care and determine its impact on antibiotic management.
They included patients from the medical ICU (MICU) who were mechanically ventilated and empirically treated with anti-MRSA antibiotics for suspected pneumonia with bronchoalveolar lavage (BAL) samples collected between May 2016 and January 2017. The primary outcome was duration of vancomycin or linezolid administration, whereas the secondary endpoints focused on safety.
Initially, Wunderink and colleagues collected consecutive residual BAL samples from intubated patients from June 2015 to April 2016 to validate the operating characteristics of the rapid automated PCR (RPCR) against culture, according to the study. The RPCR demonstrated 95.7% sensitivity and a negative likelihood ratio of 0.04 for MRSA.
Wunderink and colleagues randomly assigned 45 patients to receive antibiotic management based on RDT (n = 22) or usual care (n = 23). They highlighted a significant reduction in the duration of antibiotic administration in the intervention group. Specifically, vancomycin or linezolid administration lasted 32 hours in the intervention group compared with 72 hours in the usual care group.
The researchers also reported observing a lower trend in the proportions of complications and length of stay in the intervention group. According to the results, hospital mortality was 13.6% in the intervention group and 39.1% in the usual care group (95% CI of difference, –3.3% to 50.3%). Additionally, the intervention group had a 0.48 standardized mortality ratio compared with 1.18 for the usual care group, according to the study.
“Use of a rapid diagnostic test for suspected MRSA pneumonia to manage anti-MRSA treatment results in significant decreases in anti-MRSA treatment without adverse effects,” Wunderink concluded. – by Marley Ghizzone
Disclosures: Wunderink reports being a consultant for bioMerieux. He also reports his institution receiving grants from bioMerieux and Curetis. All other authors’ report no relevant financial disclosures.
Click Here to Manage Email Alerts