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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*
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

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
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.

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