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Cited by 66Antimicrobial Resistance in StaphylococcusAntibiotic Use and ResistanceBacterial Identification and Susceptibility Testing

Rapid Detection of Methicillin-Resistant Staphylococcus aureus in BAL

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Paonessa, Joseph R., Shah, Raj D., Pickens, Chiagozie I., Lizza, Bryan D., Donnelly, Helen K., Malczynski, Michael, Qi, Chao, Wunderink, Richard G.·2019·Chest
DOI 10.1016/j.chest.2019.02.007PMC PMC6533464
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Abstract

Background Guidelines recommend empirical vancomycin or linezolid for patients with suspected pneumonia at risk for methicillin‐resistant Staphylococcus aureus (MRSA). Unneeded vancomycin or linezolid use may unnecessarily alter host flora and expose patients to toxicity. We therefore sought to determine if rapid testing for MRSA in BAL can safely decrease use of vancomycin or linezolid for suspected MRSA pneumonia. Methods Operating characteristics of the assay were initially validated against culture on residual BAL. A prospective, unblinded, randomized clinical trial to assess the effect of antibiotic management made on the basis of rapid diagnostic testing (RDT) compared with usual care was subsequently conducted, with primary outcome of duration of vancomycin or linezolid administration. Secondary end points focused on safety. Results Sensitivity of RPCR was 95.7%, with a negative likelihood ratio of 0.04 for MRSA. The clinical trial randomized 45 patients: 22 to antibiotic management made on the basis of RDT and 23 to usual care. Duration of vancomycin or linezolid administration was significantly reduced in the intervention group (32 h [interquartile range, 22‐48] vs 72 h [interquartile range, 50‐113], P < .001). Proportions with complications and length of stay trended lower in the intervention group. Hospital mortality was 13.6% in the intervention group and 39.1% for usual care (95% CI of difference, –3.3 to 50.3, P = .06). Standardized mortality ratio was 0.48 for the intervention group and 1.18 for usual care. Conclusions A highly sensitive BAL RDT for MRSA significantly reduced use of vancomycin and linezolid in ventilated patients with suspected pneumonia. Management made on the basis of RDT had no adverse effects, with a trend to lower hospital mortality. Trial Registry ClinicalTrials.gov; No. NCT02660554; URL: www.clinicaltrials.gov.

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  1. [1]1. [Shorr AF, Tabak YP, Gupta V, Johannes RS, Liu LZ, Kollef MH. Morbidity and cost burden of methicillinresistant Staphylococcus aureus in early](http://refhub.elsevier.com/S0012-3692(19)30156-4/sref1) and we did not evaluate whether RPCR could be used to safely de-escalate to MSSA coverage alone. Finally, the results from this pilot study in a single institution may not apply to other ICUs with a different prevalence of MRSA pneumonia and/or different antibiotic stewardship patterns; results should be validated in a different cohort.

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Authors
Paonessa, J. R., Shah, R. D., Pickens, C. I., Lizza, B. D., Donnelly, H. K., Malczynski, M., Qi, C., & Wunderink, R. G.
Affiliations
  • Northwestern University (US)
  • Northwestern Memorial Hospital (US)
Corresponding author
Wunderink, Richard G.
ORCID
Venue
Chest
Publisher
Elsevier BV
Published
2019-05
Volume
155
Issue
5
Pages
999-1007
ISSN
0012-3692 (ISSN-L)
DOI
10.1016/j.chest.2019.02.007
PMC
PMC6533464
OpenAlex
W2922767990
Semantic Scholar
f28535b7294b9e1ba6a6c24d5918de852e8d4352
Cited by
66
References
44
Citations by year
2026: 3 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 14 · 2020: 16 · 2019: 1
FWCI
8.24
Type
journal article
Language
en
Open access
Licence
Locations
  • CHEST Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • Northwestern Medical Faculty Foundation
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords
methicillin-resistant Staphylococcus aureus, bronchoalveolar lavage, rapid diagnostic tests, MRSA pneumonia, vancomycin, linezolid, antibiotic stewardship, empirical antibiotic therapy, mechanically ventilated patients, in-hospital mortality, standardized mortality ratio
MeSH terms
Linezolid, Antimicrobial Stewardship, Anti-Bacterial Agents, Bacteriological Techniques, Bronchoalveolar Lavage Fluid, Diagnostic Tests, Routine, Drug Resistance, Microbial, Female, Humans, Male, Middle Aged, Pilot Projects, Pneumonia, Staphylococcal, Vancomycin, Reproducibility of Results, Methicillin-Resistant Staphylococcus aureus

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