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Medical Student

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Internal Medicine

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Internal Medicine

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Patient Care

Abstract

Background Methicillin-Resistant Staphylococcus aureus (MRSA) nasal screening is a tool which may aid in avoiding unnecessary empiric MRSA therapy for community acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP) and other infections in the inpatient setting. Appropriate antibiotic therapy is vital in minimizing hospital stay, avoidance of multi-drug resistance, and patient mortality. The objective of this project was to evaluate the use of MRSA nasal screening and understand its use which will ultimately help inform the implementation of quality improvement interventions to improve antibiotic usage at an acute care hospital in our region.

Methods From 409 inpatient visits for patients who had MRSA screening ordered between December 2021 to September 2022, we obtained a random sample of 136 hospital records (1/3). From that sample, we obtained diagnoses, MRSA nasal screening dates, MRSA report dates, vancomycin start and/or stop date, and de-escalation timelines.

Results Of 21 patients who began empiric vancomycin therapy, 11 (52%) were de-escalated within 24-72 hours of receiving a negative MRSA report. 9 (42%) patients who had a negative MRSA report were not de-escalated. 1 (4.72%) patient who had a positive MRSA report was not de-escalated.

Conclusions Preliminary results reveal that MRSA nasal screening has been used for de-escalation of unwarranted anti-MRSA agents in the acute care hospital in 52% of cases. There were 9 instances where a negative MRSA screening could have led to de-escalation of therapy but did not. This highlights future opportunities to improve antibiotic use with Quality Improvement antibiotic stewardship interventions. Additional studies are warranted to assess clinical outcomes and track the expansion of the program to other clinical sites.

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Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening as a Tool for Antibiotic Stewardship Program

Background Methicillin-Resistant Staphylococcus aureus (MRSA) nasal screening is a tool which may aid in avoiding unnecessary empiric MRSA therapy for community acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP) and other infections in the inpatient setting. Appropriate antibiotic therapy is vital in minimizing hospital stay, avoidance of multi-drug resistance, and patient mortality. The objective of this project was to evaluate the use of MRSA nasal screening and understand its use which will ultimately help inform the implementation of quality improvement interventions to improve antibiotic usage at an acute care hospital in our region.

Methods From 409 inpatient visits for patients who had MRSA screening ordered between December 2021 to September 2022, we obtained a random sample of 136 hospital records (1/3). From that sample, we obtained diagnoses, MRSA nasal screening dates, MRSA report dates, vancomycin start and/or stop date, and de-escalation timelines.

Results Of 21 patients who began empiric vancomycin therapy, 11 (52%) were de-escalated within 24-72 hours of receiving a negative MRSA report. 9 (42%) patients who had a negative MRSA report were not de-escalated. 1 (4.72%) patient who had a positive MRSA report was not de-escalated.

Conclusions Preliminary results reveal that MRSA nasal screening has been used for de-escalation of unwarranted anti-MRSA agents in the acute care hospital in 52% of cases. There were 9 instances where a negative MRSA screening could have led to de-escalation of therapy but did not. This highlights future opportunities to improve antibiotic use with Quality Improvement antibiotic stewardship interventions. Additional studies are warranted to assess clinical outcomes and track the expansion of the program to other clinical sites.

 

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