Guidelines
Anti-MRSA Coverage for Pneumonia on Admission

Anti-MRSA Coverage for Pneumonia on Admission

Guideline

Using MRSA PCR nare screens to discontinue MRSA coverage for pneumonia

Background

The overall prevalence of MRSA pneumonia on admission is 14.0%.

Staphylococcus aureus is a “hearty” organism that grows on culture easily, even when cultures are taken after antibiotics have been started. Thus, the absence of MRSA on adequate sputum culture is usually sufficient evidence to discontinuing empiric vancomycin for pneumonia.

Unfortunately 40-70% of patients fail to produce adequate respiratory tract samples for culture.

Most recently the absence of MRSA in the nares by PCR has shown to predict the absence of MRSA on adequate respiratory cultures and MRSA pneumonia (see Relevant Studies below).

Boyce JM et al. 2013 AAC concluded that it is reasonable to discontinue empiric vancomycin HCAP therapy in patients with negative MRSA PCR studies (see Relevant Studies below).

AdventHealth Tampa Protocol

The Antimicrobial Stewardship Program at AdventHealth Tampa endorses the discontinuation of empiric anti-MRSA therapy for pneumonia present on admission in patients with negative MRSA PCR of the nares (even in the absence of respiratory cultures).

Please be sure the patient was not decolonized with mupirocin or other products prior to the MRSA nares PCR screening being evaluated.

Additional Resources