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Evaluation of the negative predictive value of methicillin-resistant Staphylococcus aureus nasal swab screening in patients with acute myeloid leukemia

Published online by Cambridge University Press:  24 November 2020

Sarah K. Perreault Open the ORCID record for Sarah K. Perreault [Opens in a new window] ,
Bailee Binks ,
Dayna S. McManus  and
Jeffrey E. Topal
Sarah K. Perreault*
Affiliation:
Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut
Bailee Binks
Affiliation:
Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut
Dayna S. McManus
Affiliation:
Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut
Jeffrey E. Topal
Affiliation:
Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut Department of Internal Medicine, Section of Infectious Diseases, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
*
Author for correspondence: Sarah K. Perreault, E-mail: Sarah.Perreault@ynhh.org
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Abstract

Objective:

Methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs are utilized to guide the discontinuation of empiric MRSA therapy. In multiple studies, MRSA nasal swabs have been shown to have a negative predictive value (NPV) of ~99% in non-oncology patients with pneumonia and other infections. We evaluated the performance characteristics of a negative MRSA nasal swab in the acute myeloid leukemia (AML) populaion to determine its NPV.

Design:

Retrospective chart review.

Patients:

This study included adult AML patients with a suspected infection and a MRSA nasal swab collected between 2013 and 2018.

Methods:

MRSA nasal swab and culture-documented infections were identified to determine the sensitivity, specificity, NPV, and positive predictive value of the MRSA nasal swabs.

Results:

In total, 194 patients were identified, and 484 discrete encounters were analyzed. Overall, 468 (97%) encounters had a negative MRSA nasal swab upon admission with no cultured documented MRSA infection during their hospitalization. However, 3 encounters (0.6%) had a negative MRSA nasal swab with a subsequent cultured documented MRSA infection during their admission. Identified infections were bacteremia (n = 2) and confirmed pneumonia (n = 1). MRSA nasal swab had a sensitivity of 62% (95% CI, 0.24–0.91), specificity of 98% (95% CI, 0.96–0.99), positive predictive value of 38% (95% CI, 0.21–0.6), and NPV of 99% (95% CI, 0.98–1).

Conclusions:

A negative MRSA nasal swab has a 99% NPV for subsequent MRSA infections in AML patients with no prior history of MRSA colonization or infection. Based on these findings, a negative MRSA nasal swab can help guide de-escalation of empiric MRSA antibiotic therapy.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 7 , July 2021 , pp. 853 - 856
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: These data were presented in part at IDWeek on October 5, 2019, in Washington, DC.

References

Prevention and treatment of cancer-related infections (version 1.2019). National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf. Published 2019. Accessed October 29, 2020.Google Scholar
Freifeld, AG1, Bow, EJ, Sepkowitz, KA, et al. Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:427–431.CrossRefGoogle Scholar
Perreault, S, McManus, D, Bar, N, et al. The impact of a multimodal approach to vancomycin discontinuation in hematopoietic stem cell transplant recipients (HSCT) with febrile neutropenia (FN). Transpl Infect Dis 2019;21:e13059.CrossRefGoogle Scholar
Dangerfield, B, Chung, A, Webb, B, Seville, MT. Predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia. Antimicrob Agents Chemother 2014;58:859–864.CrossRefGoogle ScholarPubMed
Hiett, J, Patel, RK, Tate, V, Smulian, G, Kelly, A. Using active methicillin-resistant Staphylococcus aureus surveillance nasal swabs to predict clinical respiratory culture results. Am J Health Syst Pharm 2015;72:S20–S24.CrossRefGoogle ScholarPubMed
Chotiprasitsakul, D, Tamma, PD, Gadala, A, Cosgrove, SE. The role of negative methicillin-resistant Staphylococcus aureus nasal surveillance swabs in predicting the need for empiric vancomycin therapy in intensive care unit patients. Infect Control Hosp Epidemiol 2018;39:290–296.CrossRefGoogle ScholarPubMed
Schulz, M, Nonnenmacher, C, Mutters, R. Cost-effectiveness of rapid MRSA screening in surgical patients. Eur J Clin Microbiol Infect Dis 2009;28:1291–1296.CrossRefGoogle ScholarPubMed
Chan, JD, Dellit, TH, Choudhuri, JA, et al. Active surveillance cultures of methicillin-resistant Staphylococcus aureus as a tool to predict methicillin-resistant S. aureus ventilator-associated pneumonia. Crit Care Med 2012;40:1437–1442.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network (NHSN). Patient safety component manual, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/acute-care-hospital/index.html. Published 2019. Accessed October 29, 2020.Google Scholar
Centers for Disease Control and Prevention (CDC). Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients—United States, 2005. Morb Mortal Wkly Rep 2007;56:197–199.Google Scholar
Klevens, RM, Morrison, MA, Nadle, J, et al. Active Bacterial Core surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
Cometta, A, Kern, WV, De Bock, R, et al. Vancomycin versus placebo for treating persistent fever in patients with neutropenic cancer receiving piperacillin-tazobactam monotherapy. Clin Infect Dis 2003;37:382–389.CrossRefGoogle ScholarPubMed
Petersen, IS, Christensen, JM, Zeuthen, AB, Madsen, PB. Danish experience of methicillin-resistant Staphylococcus aureus eradication with emphasis on nose-throat colonization and supplementary systemic antibiotic treatment. J Hosp Infect 2019;103:461–464.CrossRefGoogle ScholarPubMed
Ammerlaan, HS, Kluytmans, JA, Wertheim, HF, et al. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009;48:922.CrossRefGoogle ScholarPubMed
Shenoy, ES, Noubary, F, Kim, J, et al. Concordance of PCR and culture from nasal swabs for detection of methicillin-resistant Staphylococcus aureus in a setting of concurrent antistaphylococcal antibiotics. J Clin Microbiol 2014;52:1235–1237.CrossRefGoogle Scholar