さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Active identification of patients who are methicillin-resistant Staphylococcus aureus colonized is not associated with longer duration of vancomycin therapy.

2017年 AJIC に発表された、 VA Boston Healthcare SystemにおけるMRSA保菌と長期VCM使用との関連性を後ろ向き調査した報告

 

 

BACKGROUND

Excessive prescribing of vancomycin among patients admitted to inpatient wards is a challenge for antimicrobial stewardship programs, especially in the setting of expanded screening programs for methicillin-resistant Staphylococcus aureus (MRSA). Studies examining factors associated with longer duration of vancomycin use are limited.

 

METHODS

We conducted a retrospective cohort study to assess the impact of universal MRSA admission screening on duration of vancomycin use at the VA Boston Healthcare System during the period from January 2013-November 2015.

 

RESULTS

A total of 2,910 patients were administered intravenous vancomycin during the study period.

A clinical culture positive for MRSA was strongly associated with vancomycin administration lasting >72 hours (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.86-3.97; P < .001).

After controlling for clinical culture results, admission MRSA colonization was not associated with vancomycin use past 72 hours (OR, 0.94; 95% CI, 0.8-1.1).

A negative MRSA nasal swab on admission had a high negative predictive value for all MRSA infections evaluated (99.6% for pneumonia, 99.6% for bloodstream infection, and 98.1% for skin and soft tissue infection).

 

CONCLUSIONS

Admission surveillance for MRSA nasal colonization is not a major driver of prolonged vancomycin use. A negative admission MRSA nasal screen may be a useful tool for antimicrobial stewardship programs to limit vancomycin use, particularly in noncritically ill patients.

 
 

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 limitations 

 

First, we were not able to evaluate other clinical factors that may have driven vancomycin use, such as recent health care exposure, β-lactam allergy, severity of disease, or other comorbidities and exposures that may have increased the risk of an MRSA infection.

 

Second, we were not able to evaluate the impact of the difference between a culture negative for MRSA and a culture that was not performed. Patients without clinical cultures may have fundamentally different diagnoses (eg, nonpurulent cellulitis) and therefore may have a different baseline risk of MRSA infections when compared with patients who did have clinical cultures taken.

 

Finally, our results are from a single inpatient VA health care system and therefore may not be applicable to other clinical settings, including outpatient parenteral antimicrobial therapy programs. Fortunately, we were able to evaluate a large cohort over multiple years and within an integrated health care system

 

感想

 

ざっくりとした報告。

限界1に記載を踏まえて、今後の検討が必要。