The current IDSA/ATS guidelines recommend Linezolid and Vancomycin for MRSA coverage in hospitalized patients with pneumonia, which is common clinical practice in Italy. However, a nasal PCR-assay for MRSA has a high negative predictive value and can facilitate rapid antibiotic de-escalation, thereby avoiding unnecessary anti-MRSA treatments. The indiscriminate use of these drugs has contributed to the emergence of resistant S. aureus strains and has led to significant adverse effects, without providing any survival benefits. Additionally, it has increased hospital stays and associated costs. The proposed study aims to use this diagnostic tool to shorten empirical anti-MRSA treatment duration in pneumonia patients, focusing on reducing antimicrobial therapy days while measuring in-hospital mortality, length of stay and adverse drug event incidence.
Subjects 18 years or older.
Patients hospitalized at the Azienda Consorziale Policlinico di Bari;
Clinical diagnosis of CAP/HAP/VAP;
Commitment by the prescribing physician to set an anti-MRSA antibiotic therapy in empirical
Febrile neutropenia or severe immunodeficiency;
Chronic airway infection (eg cystic fibrosis);
Suspect of extrapulmonary infection by MRSA
Refusal by the patient or legal guardian;
Parallel
MRSA nasal swab based de-escalation
Diagnostic testPatients included into the intervention arm will undergo a nasal swab for MRSA and empirical anti-MRSA therapy will be discontinued f the nasal swab result is negative.
Duration of antibiotic intake
In-hospital mortality
Hospital lenght-of stay
Incidence of severe pneumonia requiring mechanical ventilation
Incidence of drug-related adverse outcomes
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