K. R. Bono1, J. A. Caceda1, J. H. Lee1, H. Horng2, C. Goldstein3, Z. Sifri3, N. E. Glass3 1Rutgers New Jersey Medical School, Newark, NJ, USA 2University Hospital, Pharmacy, Newark, NJ, USA 3Rutgers New Jersey Medical School, Surgery, Newark, NJ, USA
Introduction: It is important to treat Methicillin-resistant Staphylococcus aureus (MRSA) infections aggressively, because if left untreated, they can cause severe illness and even death. However, to steward appropriate use of antibiotics, we have demonstrated that if patients do not carry MRSA, they are unlikely to have invasive MRSA infections. Therefore, it is important to screen patients who are at risk for MRSA infection so the appropriate antibiotic therapy can be initiated. There is an ongoing debate which has swung back and forth between having universal screening or universal decolonization without screening. In our population, MRSA carriage and MRSA infections are relatively rare. We therefore hope to establish appropriate guidelines for screening. Literature about the timing of repeat screening is limited. In this study, we evaluated patients with more than one admission over the study period to assess how repeat admissions should play into our guideline to limit repeat MRSA screening.
Methods: We performed a single-center retrospective chart review of all adult patient encounters from October 2019-July 2021 with MRSA PCR nasal testing on multiple encounters. We evaluated how many conversions occurred between patient encounters and the timing of those relative to those that did not develop colonization during their admissions in the hospital. For the patients that converted from positive to negative on a subsequent encounter, chart review was conducted to look for possible decolonization with mupirocin and/or anti-MRSA antibiotics.
Results: 192 patients had MRSA PCR nasal testing on multiple encounters. 36 patients tested positive during their initial admission and 24 patients testing positive on their second admission. 33 patients had a third encounter, with 3 patients staying consistent positive. 6 patients had a fourth encounter, with 1 patient staying consitstent positive. 82% of patients who were consistent MRSA positive received appropriate MRSA therapy during their previous encounter.
Conclusion: Overall patients who screen MRSA positive are likely to screen positive during subsequent encounters despite use of antibiotics to treat and/or decolonize against MRSA. With the push for increased decolonization protocols, considering judicious use of MRSA screening in patients requiring empiric antibiotics may help identify those at risk.
