Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes
Abstract Objective: To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics. Design: Retrospective cohort study. Setting: PINC-A1 Healthcare Database (2008–2021). Pa...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25100934/type/journal_article |
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| _version_ | 1849335595898241024 |
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| author | Hayley B. Gershengorn Hannah Wunsch Bhavarth Shukla |
| author_facet | Hayley B. Gershengorn Hannah Wunsch Bhavarth Shukla |
| author_sort | Hayley B. Gershengorn |
| collection | DOAJ |
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Abstract
Objective:
To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics.
Design:
Retrospective cohort study.
Setting:
PINC-A1 Healthcare Database (2008–2021).
Participants:
Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.
Methods:
We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital.
Results:
We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0–37.6%; full range: 0%–98.0%]; median odds ratio [95% CI]: 84.7 [63.3–115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%–0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04–1.31], P = .007).
Conclusions:
Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration.
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| format | Article |
| id | doaj-art-25f746eda09e4c009df2b4a6d1b8c689 |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-25f746eda09e4c009df2b4a6d1b8c6892025-08-20T03:45:14ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.10093Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomesHayley B. Gershengorn0https://orcid.org/0000-0002-7360-2489Hannah Wunsch1https://orcid.org/0000-0001-5477-8422Bhavarth Shukla2Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Anesthesiology, Weill Cornell Medical College, New York, NY, USA Sunnybrook Research Institute, Toronto, ON, Canada Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, CanadaDivision of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA Abstract Objective: To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics. Design: Retrospective cohort study. Setting: PINC-A1 Healthcare Database (2008–2021). Participants: Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1. Methods: We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital. Results: We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0–37.6%; full range: 0%–98.0%]; median odds ratio [95% CI]: 84.7 [63.3–115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%–0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04–1.31], P = .007). Conclusions: Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration. https://www.cambridge.org/core/product/identifier/S2732494X25100934/type/journal_article |
| spellingShingle | Hayley B. Gershengorn Hannah Wunsch Bhavarth Shukla Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes |
| title_full | Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes |
| title_fullStr | Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes |
| title_full_unstemmed | Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes |
| title_short | Methicillin-resistant Staphylococcus aureus nasal swabs: trends in use and association with outcomes |
| title_sort | methicillin resistant staphylococcus aureus nasal swabs trends in use and association with outcomes |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25100934/type/journal_article |
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