Gershengorn Hayley B, Wunsch Hannah, Shukla Bhavarth
Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Aug 7;5(1):e177. doi: 10.1017/ash.2025.10093. eCollection 2025.
To investigate patterns of early methicillin-resistant (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics.
Retrospective cohort study.
PINC-A1 Healthcare Database (2008-2021).
Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1.
We assessed interhospital variation and time trends in early polymerase chain reaction-based MRSA nasal swab use using bivariable regression. Next, we used competing risks multivariable regression to assess the association of early (started by hospital day 2) anti-MRSA antibiotic duration with care in a high (≥90%) versus low (<10%) swab use hospital.
We included 699,474 patients across 788 hospitals to evaluate trends in early swab use; 151,205 (21.6%) received a swab. Use of swabs varied across hospitals (median use: 6.0% [interquartile range: 0-37.6%; full range: 0%-98.0%]; median odds ratio [95% CI]: 84.7 [63.3-115.6]) and overall use increased over time (3.5% in 2008 quarter 1 increasing to 29.5% in 2021 quarter 4; regression coefficient [95% CI]: 0.14% [0.12%-0.15%]). Considering 41,599 patients (9,796 [23.6%] in 33 hospitals where ≥90% received swabs and 31,763 [76.4%] in 67 hospitals with <10% use), anti-MRSA antibiotic durations were shorter in hospitals where ≥90% (vs < 10%) received a swab (adjusted sub-hazard ratio for discontinuation of antibiotics [95% CI]: 1.17 [1.04-1.31], = .007).
Use of early polymerase chain reaction-based MRSA nasal swabs varied across US hospitals and increased over time. Receiving care in a hospital with higher swab use was associated with shorter anti-MRSA antibiotic duration.
调查美国医院早期耐甲氧西林金黄色葡萄球菌（MRSA）鼻拭子检测的使用模式及其与MRSA特异性抗生素降阶梯治疗的相关性。
回顾性队列研究。
PINC-A1医疗数据库（2008 - 2021年）。
入院时患有脓毒症且在住院第1天接受有创机械通气的成年人。
我们使用双变量回归评估基于早期聚合酶链反应的MRSA鼻拭子检测在不同医院间的差异和时间趋势。接下来，我们使用竞争风险多变量回归评估在高拭子使用率（≥90%）与低拭子使用率（<10%）医院中，早期（住院第2天开始）抗MRSA抗生素使用时长与治疗的相关性。
我们纳入了788家医院的699474例患者以评估早期拭子检测的使用趋势；151205例（21.6%）接受了拭子检测。不同医院的拭子使用率不同（中位使用率：6.0% [四分位间距：0 - 37.6%；全距：0% - 98.0%]；中位比值比[95%置信区间]：84.7 [63.3 - 115.6]），且总体使用率随时间增加（2008年第一季度为3.5%，增至2021年第四季度的29.5%；回归系数[95%置信区间]：0.14% [0.12% - 0.15%]）。在41599例患者中（33家医院中有9796例[23.6%]，拭子使用率≥90%，67家医院中有31763例[76.4%]，拭子使用率<10%），在拭子使用率≥90%（对比<10%）的医院中，抗MRSA抗生素使用时长更短（抗生素停用的调整后亚风险比[95%置信区间]：1.17 [1.04 - 1.31]，P = 0.007）。
美国医院中基于早期聚合酶链反应的MRSA鼻拭子检测的使用情况因医院而异且随时间增加。在拭子使用率较高的医院接受治疗与较短的抗MRSA抗生素使用时长相关。
