Emergency department methicillin-resistant Staphylococcus aureus nare screen effect on pneumonia treatment duration

Abstract

Study objective: The objective of this study was to determine if performing a methicillin-resistant Staphylococcus aureus (MRSA) nasal screen in the emergency department (ED) decreased general medicine patient exposure to anti-MRSA antibiotics for pneumonia.

Methods: This was a single-center, retrospective study evaluating patients who had a diagnosis of pneumonia and were initiated on anti-MRSA therapy (vancomycin or linezolid) in the ED and subsequently admitted to a general medicine floor. Patients were divided into two groups: 1) did not receive a MRSA nares screen in the ED (No MRSA screen group) or 2) received a MRSA nares screen in the ED (MRSA screen group). The primary outcome was anti-MRSA antibiotic duration. Secondary outcomes included vancomycin level evaluation, hospital survival, and acute kidney injury.

Results: Of the 116 patients included, 37 patients received a MRSA nares screen in the ED and 79 patients did not. Median duration of antibiotic exposure was similar for both groups (No MRSA screen, 30.5 h [interquartile range (IQR) 20.5-52.5] vs. MRSA screen, 24.5 h [IQR 20.6-40.3]; p = 0.28). Of patients who were screened, 35 were negative and 2 were positive. Secondary outcomes were similar.

Conclusion: Performing a MRSA nares screen in the ED for patients diagnosed with pneumonia, initiated on anti-MRSA antibiotics, and admitted to a general medicine floor did not decrease duration of anti-MRSA antibiotics. At this time, ED providers do not need to consider a MRSA nasal screen in the ED for patients being admitted to general medicine, although larger studies could be considered.

Keywords: Antibiotic stewardship; Methicillin-resistant Staphylococcus aureus (MRSA); Nares; Pneumonia; Screen; Vancomycin.