Nasal methicillin-resistant Staphylococcus aureus polymerase chain reaction: a potential use in guiding antibiotic therapy for pneumonia

Perm J. 2015 Winter;19(1):34-6. doi: 10.7812/TPP/14-101. Epub 2014 Nov 24.

Abstract

Context: The role at admission of nasal polymerase chain reaction (PCR) for patients with methicillin-resistant Staphylococcus aureus (MRSA) in guiding antibiotic therapy for lower respiratory tract infection is unknown.

Objective: To determine whether nasal MRSA PCR at admission can predict the absence of MRSA in lower respiratory tract secretions.

Design: We performed a retrospective study of adult patients admitted to a large urban hospital. Patients had a nasal MRSA PCR test and a lower respiratory tract culture obtained within 48 hours of admission and the culture yielded S aureus.

Main outcome measures: Sensitivity, specificity, and positive and negative predictive values.

Results: Our results showed high sensitivity (93.3%) and negative predictive value (95.2%) of nasal PCR for MRSA in the lower respiratory tract.

Conclusion: With its high sensitivity and negative predictive value, a nasal MRSA PCR test performed within 48 hours of hospital admission could help guide the discontinuation of MRSA-directed empiric antibiotic therapy in patients who are unlikely to be infected with this organism. A prospective study is needed to confirm these findings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Carrier State / diagnosis*
  • Carrier State / drug therapy
  • Carrier State / microbiology
  • Female
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Middle Aged
  • Nasal Cavity / microbiology*
  • Pneumonia, Staphylococcal / diagnosis*
  • Pneumonia, Staphylococcal / drug therapy
  • Pneumonia, Staphylococcal / microbiology
  • Polymerase Chain Reaction / statistics & numerical data*
  • Predictive Value of Tests
  • Prospective Studies
  • Retrospective Studies
  • Sensitivity and Specificity

Substances

  • Anti-Bacterial Agents