Jennifer A Johnson1, Michael E Wright2, Lyndsay A Sheperd3, Daniel M Musher4, Bich N Dang5. 1. Pulmonary and Critical Care Physician at Centennial Medical Center in Nashville, TN. jennifer03johnson@yahoo.com. 2. Clinical Pharmacist at Williamson County Medical Center in Franklin, TN. michaelwright54@hotmail.com. 3. Clinical Pharmacist at Texas Health Presbyterian Hospital in Dallas, TX. LyndsaySheperd@texashealth.org. 4. Professor of Medicine in the Section of Infectious Diseases at Baylor College of Medicine in Houston, TX. daniel.musher@va.gov. 5. Assistant Professor of Medicine in the Section of Infectious Diseases at Baylor College of Medicine in Houston, TX. bndang@bcm.edu.
Abstract
CONTEXT: The role at admission of nasal polymerase chain reaction (PCR) for patients with methicillin-resistant Staphylococcus aureus (MRSA) in guiding antibiotic therapy for lower respiratory tract infection is unknown. OBJECTIVE: To determine whether nasal MRSA PCR at admission can predict the absence of MRSA in lower respiratory tract secretions. DESIGN: We performed a retrospective study of adult patients admitted to a large urban hospital. Patients had a nasal MRSA PCR test and a lower respiratory tract culture obtained within 48 hours of admission and the culture yielded S aureus. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values. RESULTS: Our results showed high sensitivity (93.3%) and negative predictive value (95.2%) of nasal PCR for MRSA in the lower respiratory tract. CONCLUSION: With its high sensitivity and negative predictive value, a nasal MRSA PCR test performed within 48 hours of hospital admission could help guide the discontinuation of MRSA-directed empiric antibiotic therapy in patients who are unlikely to be infected with this organism. A prospective study is needed to confirm these findings.
CONTEXT: The role at admission of nasal polymerase chain reaction (PCR) for patients with methicillin-resistant Staphylococcus aureus (MRSA) in guiding antibiotic therapy for lower respiratory tract infection is unknown. OBJECTIVE: To determine whether nasal MRSA PCR at admission can predict the absence of MRSA in lower respiratory tract secretions. DESIGN: We performed a retrospective study of adult patients admitted to a large urban hospital. Patients had a nasal MRSA PCR test and a lower respiratory tract culture obtained within 48 hours of admission and the culture yielded S aureus. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values. RESULTS: Our results showed high sensitivity (93.3%) and negative predictive value (95.2%) of nasal PCR for MRSA in the lower respiratory tract. CONCLUSION: With its high sensitivity and negative predictive value, a nasal MRSA PCR test performed within 48 hours of hospital admission could help guide the discontinuation of MRSA-directed empiric antibiotic therapy in patients who are unlikely to be infected with this organism. A prospective study is needed to confirm these findings.
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