Category: Federal Forum Posters
Purpose: The Veterans Health Administration (VHA) began its “methicillin-resistant Staphylococcus aureus (MRSA) bundle” initiative in 2007, which consisted of screening every patient at admission and discharge for MRSA nares colonization. There are small to moderately sized studies and one meta-analysis suggesting that the absence of MRSA detection via nares swab be used as an antimicrobial stewardship tool to deescalate therapy for pneumonia. The evidence for other infections is less certain. The objective of this study is to use nationwide data to determine if colonization correlates with MRSA infection in pulmonary infections, surgical site infections, and skin and soft tissue infections (SSTIs).
Methods: This is a retrospective cohort study across VHA medical centers nationwide. Data will be obtained using bio-informatics across all VHA hospitals from the corporate data warehouse (CDW). Structure Query Language (SQL) will be used to manage data from the CDW. All VHA patients 18 years of age or older who were tested for MRSA colonization via the nares between January 1, 2007 and July 16, 2018 will be included in the study. Data collected will include patient demographics, nasal swab results via polymerase chain reaction (PCR) or culture, culture results, culture type, antibiotic use proximal to culture, use of empirical MRSA-active agents, testing methods (PCR vs. other), surgeries, surgical sites, duration from surgeries, dates of testing, dates of admission, dates of cultures, labs, and vitals. Descriptive statistics will be used to compare demographic and clinical characteristics between cohorts. Percentages will be used to evaluate the prevalence of MRSA nares colonization from January 1, 2007 to July 16, 2018. The sensitivity, specificity, positive predictive value, and negative predictive value will be calculated to evaluate the use of the MRSA nasal swab in detecting culture-confirmed MRSA infections for pulmonary infections, surgical site infections, and SSTIs.
Kaitlyn Victor– PGY1 Pharmacy Resident, Western New York Veterans Affairs Healthcare System, Buffalo, NY