Sonya Kedzior, PharmD, BCCCP
Critical Care Pharmacist
University of Colorado Hospital
Aurora, CO
Disclosure information not submitted.
Noah Minor, MD
Medical Resident
University of Colorado, United States
Disclosure information not submitted.
Kyle Molina, PharmD
Infectious Disease Pharmacist
University of Colorado Hospital, United States
Disclosure information not submitted.
Scott Mueller, PharmD, BCCCP,FCCM
Associate Professor
University of Colorado Skaggs School of Pharmacy, United States
Disclosure information not submitted.
Matthew Miller, PharmD
Infectious Disease Pharmacist
University of Colorado Hospital, United States
Disclosure information not submitted.
Title: Methicillin-Resistant Staphylococcus Aureus Nasal Swabs in Pneumonia: A Cost-Effectiveness Analysis
INTRODUCTION: Pneumonia remains a leading cause of death in the United States. Rare but significant pathogens such as, Staphylococcus aureus, are infrequently identified in clinical practice complicating empiric antimicrobial therapy choices and duration of treatment. Utilizing methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal swabs, may aid in antimicrobial de-escalation to decrease unnecessary exposure, incidence of adverse effects and hospital costs associated with anti-MRSA therapy.
Methods: Data of eligible adult patients admitted to the University of Colorado Hospital (UCH) were collected via chart review between November 2019 through November 2020. The primary objective of this study was to evaluate the financial impact of a pharmacist-driven MRSA PCR nasal swab protocol for the de-escalation of empiric anti-MRSA therapy in patients with pneumonia. Costs associated with empiric MRSA therapy were compared in patients with no MRSA nasal screening (pre-implementation) versus negative MRSA nasal screening (post-implementation). This study will further assess the economic cost-benefit of purchasing a nasal PCR machine for MRSA nasal screening in an academic healthcare setting.
Results: A total of 169 patients who received empiric anti-MRSA antimicrobial therapy for pneumonia were included in the study. Current population demographics include those who are on average 57 (SD 16) years of age, male (59%), and Caucasian (65%). Preliminary data suggests that protocolization of an anti-MRSA PCR nasal swab test reduced the duration of anti-MRSA therapy from a median of 3 days (IQR 2, 5) to 1 day (IQR 0.5, 2). Cost-saving measures beyond days-free of unnecessary antibiotics to be investigated will include, pharmacy personnel time, nursing blood draws, laboratory costs, and other associated costs such as hospital resource utilization.
Conclusions: Nasal screening for MRSA pneumonia has the potential to accelerate de-escalation from unnecessary antibiotic coverage thereby decreasing both direct and indirect antibiotic associated costs. This work will aim to provide other institutions an algorithm, that based on their center’s volume of testing, an estimated potential break-even point as to when purchasing and instituting a PCR machine would be justified.