MRSA colonization status as a predictor of clinical infection: A systematic review and meta-analysis - 09/12/18
Highlights |
• | MRSA screening swabs are widely used to detect patients colonized with MRSA. |
• | We reviewer the literature on MRSA swabs as markers MRSA infections. |
• | Swabs can be used to infer the bacterial etiology behind multiple infectious syndromes. |
• | This could have a significant impact on anti-microbial stewardship programs. |
Summary |
Background: Vancomycin is often used as empiric therapy for methicillin-resistant Staphylococcus aureus (MRSA), but can be associated with clinically important adverse events including renal failure. MRSA colonization swabs are primarily used for infection control; their use as a diagnostic test to inform the decision to add empiric vancomycin therapy has not been well elucidated.
Methods: We performed a Medline and Embase systematic review for peer-reviewed studies reporting the diagnostic accuracy of using MRSA colonization status to predict MRSA infections. Meta-analysis was performed using Cochrane guidelines. Grey literature was excluded.
Findings: 29 studies were included involving 24225 patients. In cases where the pathogen is not known to be S. aureus, specificities were greater than 85% for bacteremia, lower respiratory tract infections, skin and soft tissue infections (SSTI), and all infections pooled together. Sensitivities ranged between 54.0% and 77.5%. In cases where the pathogen is known to be S. aureus, we found studies on bacteremia and SSTI and arrived at pooled estimates of sensitivities ranging between 56.6% and 56.9%, and of specificities greater than 91%. Most importantly, for most infections in settings where the prevalence of MRSA as a causative organism is below 15%, the negative predictive value of a negative MRSA colonization swab exceeds 90%.
Interpretations: In settings of low-moderate MRSA prevalence, negative MRSA screening swabs may prevent unnecessary vancomycin use. More research is needed to assess if this strategy can mitigate the cost of screening in areas with a low MRSA colonization rate.
Le texte complet de cet article est disponible en PDF.Keywords : Methicillin-resistant Staphylococcus aureus, Bacteremia, Empiric therapy, Vancomycin, Beta-lactam, Colonization
Plan
Vol 77 - N° 6
P. 489-495 - décembre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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