2025/01/01 by Hayley B. Gershengorn, Hannah Wunsch, Bhavarth Shukla · 1 voice
Medicine · #Nosocomial Infections in ICU #Infection Control in Healthcare #Antimicrobial Resistance in Staphylococcus
paper · pdf · doi:10.1017/ash.2025.10093
openalex publication_date 2025/01/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
Abstract Objective: To investigate patterns of early methicillin-resistant Staphylococcus aureus (MRSA) nasal swab use in US hospitals and the association with de-escalation of MRSA-specific antibiotics. Design: Retrospective cohort study. Setting: PINC-A1 Healthcare Database (2008–2021). Participants: Adults with sepsis present on admission who received invasive mechanical ventilation by hospital day 1. Methods: 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. Results: 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], P = .007). Conclusions: 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.