Predictive values of methicillin-resistant Staphylococcus aureus nasal swabs for pneumonia in burn ICU patients.

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Burns Pub Date : 2024-09-02 DOI:10.1016/j.burns.2024.08.025

Zachary Carlson, Robyn Stoianovici, Sierra Young, Jeremiah Duby, Erin Louie

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Abstract

Introduction/objective: This retrospective cohort study aimed to determine the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of MRSA nasal swabs for pneumonia in burn-injured intensive care unit (ICU) patients.

Methods: Patients 18 years or older admitted to the Burn ICU at a tertiary medical center from 2016 to 2021 were included if they had any burns, a pneumonia ICD-10 code, an MRSA nasal swab obtained during admission, and any respiratory cultures associated with at least five consecutive days of antibiotics.

Results: There were 267 occurrences of pneumonia across 136 patients. MRSA nasal swabs had an overall sensitivity of 39 %, specificity of 98.7 %, PPV of 84.2 %, and NPV of 89.9 %. MRSA nasal swabs obtained less than seven days from antibiotic initiation had a specificity of 98.6 % and NPV of 98.6 %; meanwhile, swabs obtained at least seven days from antibiotic initiation had a specificity of 98.7 % and NPV of 86.4 %.

Conclusions: The high specificity and NPV indicate that negative MRSA nasal swabs obtained less than seven days from antibiotic initiation may be used to de-escalate anti-MRSA antibiotics in clinically stable burn-injured patients with suspicion of pneumonia. The decrease in NPV suggests that it may be beneficial to obtain a repeat swab periodically.

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耐甲氧西林金黄色葡萄球菌鼻拭子对烧伤重症监护病房患者肺炎的预测价值。

导言/目的：这项回顾性队列研究旨在确定烧伤重症监护室（ICU）患者MRSA鼻拭子检测肺炎的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）：2016年至2021年期间，一家三级医疗中心的烧伤重症监护病房收治了18岁或18岁以上的患者，如果他们有烧伤、肺炎ICD-10代码、入院时获得MRSA鼻拭子、任何与至少连续5天使用抗生素相关的呼吸道培养，则将其纳入研究范围：结果：136 名患者中共有 267 例肺炎。MRSA 鼻拭子的总体灵敏度为 39%，特异性为 98.7%，PPV 为 84.2%，NPV 为 89.9%。在开始使用抗生素不到七天时获得的 MRSA 鼻拭子的特异性为 98.6%，NPV 为 98.6%；而在开始使用抗生素至少七天时获得的拭子的特异性为 98.7%，NPV 为 86.4%：较高的特异性和 NPV 表明，对于临床病情稳定、怀疑患有肺炎的烧伤患者，在开始使用抗生素不到 7 天时获得的 MRSA 阴性鼻拭子可用于降低抗 MRSA 抗生素的使用剂量。NPV 的下降表明，定期重复采集鼻拭子可能是有益的。

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.