Department of Pharmacy, The Miriam Hospital, Providence, Rhode Island.
Infectious Disease Division, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island.
Clin Infect Dis. 2018 Jun 18;67(1):1-7. doi: 10.1093/cid/ciy024.
Recent literature has highlighted methicillin-resistant Staphylococcus aureus (MRSA) nasal screening as a possible antimicrobial stewardship program tool for avoiding unnecessary empiric MRSA therapy for pneumonia, yet current guidelines recommend MRSA therapy based on risk factors. The objective of this meta-analysis was to evaluate the diagnostic value of MRSA nasal screening in MRSA pneumonia.
PubMed and EMBASE were searched from inception to November 2016 for English studies evaluating MRSA nasal screening and development of MRSA pneumonia. Data analysis was performed using a bivariate random-effects model to estimate pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Twenty-two studies, comprising 5163 patients, met our inclusion criteria. The pooled sensitivity and specificity of MRSA nares screen for all MRSA pneumonia types were 70.9% and 90.3%, respectively. With a 10% prevalence of potential MRSA pneumonia, the calculated PPV was 44.8%, and the NPV was 96.5%. The pooled sensitivity and specificity for MRSA community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) were 85% and 92.1%, respectively. For CAP and HCAP both the PPV and NPV increased, to 56.8% and 98.1%, respectively. In comparison, for MRSA ventilated-associated pneumonia, the sensitivity, specificity, PPV, and NPV were 40.3%, 93.7%, 35.7%, and 94.8%, respectively.
Nares screening for MRSA had a high specificity and NPV for ruling out MRSA pneumonia, particularly in cases of CAP/HCAP. Based on the NPV, MRSA nares screening is a valuable tool for AMS to streamline empiric antibiotic therapy, especially among patients with pneumonia who are not colonized with MRSA.
最近的文献强调了耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔筛查作为一种可能的抗菌药物管理计划工具，用于避免对肺炎进行不必要的经验性 MRSA 治疗，但目前的指南建议根据危险因素进行 MRSA 治疗。本荟萃分析的目的是评估 MRSA 鼻腔筛查在 MRSA 肺炎中的诊断价值。
从建库到 2016 年 11 月，通过 PubMed 和 EMBASE 搜索评估 MRSA 鼻腔筛查和 MRSA 肺炎发展的英文研究。使用双变量随机效应模型进行数据分析，以估计合并敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
22 项研究，共 5163 例患者，符合我们的纳入标准。所有 MRSA 肺炎类型的 MRSA 鼻腔筛查的合并敏感性和特异性分别为 70.9%和 90.3%。在潜在 MRSA 肺炎患病率为 10%的情况下，计算出的 PPV 为 44.8%，NPV 为 96.5%。MRSA 社区获得性肺炎（CAP）和医疗保健相关性肺炎（HCAP）的合并敏感性和特异性分别为 85%和 92.1%。对于 CAP 和 HCAP，PPV 和 NPV 均增加，分别为 56.8%和 98.1%。相比之下，MRSA 呼吸机相关性肺炎的敏感性、特异性、PPV 和 NPV 分别为 40.3%、93.7%、35.7%和 94.8%。
MRSA 鼻腔筛查对排除 MRSA 肺炎具有很高的特异性和 NPV，特别是在 CAP/HCAP 情况下。基于 NPV，MRSA 鼻腔筛查是 AMS 简化经验性抗生素治疗的有价值工具，特别是在非 MRSA 定植的肺炎患者中。
