Department of Pharmacy, Florida Hospital Orlando, Orlando, Florida.
Department of Pharmacy, Seton Healthcare Family, Dell Seton Medical Center at The University of Texas, Austin, Texas.
Pharmacotherapy. 2018 Dec;38(12):1216-1228. doi: 10.1002/phar.2188. Epub 2018 Oct 29.
Significant clinical and financial consequences are associated with both inadequate and unnecessary exposure to broad-spectrum antibiotics. As such, antimicrobial stewardship programs seek objective, reliable, and cost-effective tests to identify patients at highest or lowest risk for drug-resistant organisms to guide empirical antimicrobial selection. Use of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA in lower respiratory tract infections has led to significant reductions in duration of vancomycin therapy. The clinical utility of MRSA nasal screening in other types of infection remains less clear. This review describes the performance of MRSA nasal screening in predicting MRSA infection, highlights practical considerations for use of MRSA nasal screening, and provides guidance for incorporating MRSA nasal screening into clinical practice. With a high negative predictive value when the prevalence of MRSA is low, MRSA nasal screening is a valuable antimicrobial stewardship tool with potential applications beyond lower respiratory tract infections. In appropriately selected patients, negative MRSA nasal screening can prevent initiation or guide discontinuation of anti-MRSA therapy. Antimicrobial stewardship programs should develop institutional guidelines to promote proper use of MRSA nasal screening. Pharmacists are well positioned to assist with education, interpretation, and application of MRSA nasal screening results.
不适当和不必要地使用广谱抗生素会带来重大的临床和经济后果。因此，抗菌药物管理计划寻求客观、可靠和具有成本效益的检测方法，以确定对耐药菌感染风险最高或最低的患者，从而指导经验性抗菌药物选择。使用耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔筛查来排除下呼吸道感染中的 MRSA，已显著减少了万古霉素治疗的持续时间。MRSA 鼻腔筛查在其他类型感染中的临床应用效果尚不清楚。本综述描述了 MRSA 鼻腔筛查在预测 MRSA 感染方面的表现，强调了使用 MRSA 鼻腔筛查的实际考虑因素，并为将 MRSA 鼻腔筛查纳入临床实践提供了指导。当 MRSA 的流行率较低时，MRSA 鼻腔筛查具有较高的阴性预测值，是一种有价值的抗菌药物管理工具，除了下呼吸道感染之外，还有潜在的应用。在适当选择的患者中，MRSA 鼻腔筛查阴性可预防或指导停止抗 MRSA 治疗。抗菌药物管理计划应制定机构指南，以促进 MRSA 鼻腔筛查的正确使用。药剂师非常适合协助进行 MRSA 鼻腔筛查结果的教育、解释和应用。
