• Sean Bennett, Chanda Mullen, Bhavin Mistry, and Michaelia Cucci.
• Cleveland Clinic Akron General, Akron, Ohio, USA.
• Pharmacotherapy. 2021 Mar 1; 41 (3): 257-264.

Study ObjectiveIntra-abdominal infections (IAIs) are a common reason for intensive care unit (ICU) admissions, and methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon pathogen in IAIs. Although more data are available in the setting of non-abdominal sources, there are limited data on the performance of nasal MRSA screening for MRSA IAIs. The primary objective of this study was to evaluate the performance of nasal MRSA screening for MRSA IAIs in critically ill adult patients.DesignThis was a multicenter, retrospective, cohort study.SettingA 14-hospital healthcare system between January 1, 2014, and August 31, 2019.PatientsAdult patients admitted to an ICU for at least 24 h with a diagnosis code for an IAI, a nasal MRSA surveillance screen within 30 days, and an intra-abdominal culture were eligible for inclusion.InterventionThe primary outcome was to evaluate the performance of nasal MRSA screening for MRSA IAIs by calculating the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Measurements And Main ResultsOut of 863 patients randomly screened, a total of 192 patients were included. The study population had a mean age of 60 (SD ±15) years, and 101 (53%) patients were male. Six (3.1%) patients were positive for an MRSA IAI, of which four (66.7%) demonstrated a positive nasal MRSA screen. A total of 186 (96.8%) patients were negative for a MRSA IAI, of which 19 (10.2%) were nasal MRSA-positive and 167 (89.8%) were nasal MRSA-negative. Nasal MRSA screening demonstrated the following performance: accuracy 89.1% (95% CI: 83.8%-93.1%), sensitivity 66.7% (95% CI: 22.3%-95.7%), specificity 89.8% (95% CI: 84.5%-93.7%), PPV 17.4% (95% CI: 9.4%-30.0%), and NPV 98.8% (95% CI: 96.4%-99.6%). There were no significant differences in clinical outcomes, including renal replacement-free days, ICU and hospital length of stay, and in-hospital mortality.ConclusionsAmong critically ill adult patients with IAIs, a negative nasal MRSA screen within 30 days may help to empirically exclude MRSA as a causative pathogen.© 2020 Pharmacotherapy Publications, Inc.

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