Nicolas Tran, BCPS, PharmD
PGY-2 Critical Care Pharmacy Resident
Tampa General Hospital
Tampa, Florida
Disclosure information not submitted.
David Ragoonanan, PharmD, BCCCP,
Critical Care Pharmacist
SARASOTA MEMORIAL HOSPITAL
Sarasota, Florida
Disclosure information not submitted.
Nicholas Piccicacco, PharmD, BCIDP, AAHIVP
Infectious Disease Pharmacist
Tampa General Hospital, United States
Disclosure information not submitted.
Kristen Zeitler, PharmD, BCPS
Infectious Disease Pharmacist
Tampa General Hospital, United States
Disclosure information not submitted.
Maresa Glass, PharmD, BCCCP,FCCM
Pharmacotherapy Specialist Coordinator- Critical Care
Tampa General Hospital, United States
Disclosure information not submitted.
Title: Nasal MRSA Screen Performance After Intranasal Povidone Iodine Decolonization
Introduction: The nasal methicillin resistant Staphyloccocus aureus (MRSA) polymerase chain reaction (PCR) screen has important antimicrobial stewardship implications for respiratory infections. The MRSA PCR test has a high negative predictive value for MRSA pulmonary infections. Universal decolonization with mupirocin prior to the assay may reduce the reliability of the screen. Intranasal povidone iodine is an alternative agent used for universal decolonization in the ICU. The impact of the nasal MRSA PCR screen’s negative predictive value after the use of intranasal povidone iodine has not been evaluated, so our objective was to evaluate the performance of the nasal MRSA screening test after administration of povidone iodine.
Methods: We conducted a single-center, retrospective study that evaluated the performance of a nasal MRSA screen in critically ill, adult patients undergoing intranasal povidone iodine suppression from January 1st, 2020 to June 1st, 2021. Patients were included if they received intravenous vancomycin for a suspected pulmonary infection and had blood and/or respiratory cultures available. Exclusion criteria were as follows: coinfection from a presumed nonpulmonary source, known MRSA infection in the 30 days prior to the MRSA nasal screen, more than one dose of an anti-MRSA agent (other than vancomycin) prior to the PCR assay, MRSA screen more than 14 days before suspected infection, pregnancy, incarceration, and active severe acute respiratory syndrome coronavirus 2 infection. The primary outcome was the negative predictive value of the nasal MRSA screen.
Results: A total of 201 patients were screened for eligibility. 150 patients were excluded leaving 51 patients eligible for analysis. 32 patients received povidone iodine before the MRSA screen, and 19 patients received povidone iodine after the MRSA screen. Notably, none of the included patients had a positive MRSA culture. The negative predictive value of the nasal MRSA screen was 100% in both groups. Furthermore, specificity of the screen was 90.6% and 94.7% in the before and after groups, respectively.
Conclusions: Preliminary data from this project suggests that the MRSA PCR screen may retain its reliability even if conducted after the administration of povidone iodine. Further prospective studies are needed to validate these results.