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2013 ; 5
(ä): 17-22
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Feasibility of rapid polymerase chain reaction for detection of
methicillin-resistant Staphylococcus aureus colonization among emergency
department patients with abscesses
#MMPMID27147869
Pulia MS
; Calderone M
; Hansen B
; Stake CE
; Cichon M
; Li Z
; Safdar N
Open Access Emerg Med
2013[]; 5
(ä): 17-22
PMID27147869
show ga
PURPOSE: In the era of community-associated methicillin-resistant Staphylococcus
aureus (MRSA), clinicians face a difficult challenge when selecting antibiotics
to treat abscesses. The lack of rapid diagnostics capable of identifying the
causative organism often results in suboptimal antibiotic stewardship practices.
Although not fully elucidated, the association between MRSA colonization and
subsequent infection represents an opportunity to enhance antibiotic selectivity.
Our primary objective was to examine the feasibility of utilizing a rapid
polymerase chain reaction (PCR) system (Cepheid's GeneXpert(®)) to detect MRSA
colonization prior to patient discharge in the emergency department (ED).
METHODS: This feasibility study was conducted at a tertiary care, urban, academic
ED. Patients presenting with a chief complaint related to a potential abscess
during daytime hours over an 18-week period were screened for eligibility.
Subjects were enrolled into either the PCR swab protocol group (two-thirds) or
traditional care group (one-third). PCR swabs were obtained from known MRSA
carriage sites (nasal, pharyngeal) and the superficial aspect of the wound.
RESULTS: The two groups were similar in terms of demographics, abscess location,
and MRSA history. The PCR results were available prior to patient discharge in
100% of cases. The turnaround times in minutes for the PCR swabs were as follows:
nasal 73 ± 7, pharyngeal 82 ± 14, and superficial wound 79 ± 17. No significant
difference in length of stay was observed between the two groups. The observed
ideal antibiotic selection rates improved by 45% in the PCR group, but this trend
was not significant (P = 0.08). CONCLUSION: When collected in triage, PCR swabs
demonstrated turnaround times that were effective for use in the ED setting.
Utilizing a rapid PCR MRSA colonization detection assay for ED patients with
abscesses did not adversely impact the length of stay. Real-time determination of
MRSA colonization may represent an opportunity to improve antibiotic selectivity
in the treatment of abscesses.