Impact of antimicrobial stewardship with the Xpert MRSA/SA BC assay at a tertiary hospital in Japan |
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| Affiliation: | 1. Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan;2. Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8586, Japan;3. Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan;4. Bacteriology, Osaka Metropolitan University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan;1. Department of Clinical Laboratory Medicine, Saitama Medical University Hospital, Saitama, Japan;2. Department of General Internal Medicine, Saitama Medical University Hospital, Saitama, Japan;3. Department of Nephrology, Saitama Medical University Hospital, Saitama, Japan;4. Department of Endocrinology and Diabetes, Saitama Medical University Hospital, Saitama, Japan;5. Department of Gastroenterology and Hepatology, Saitama Medical University Hospital, Saitama, Japan;6. Department of Rheumatology and Applied Immunology, Saitama Medical University Hospital, Saitama, Japan;7. Department of Respiratory Medicine, Saitama Medical University Hospital, Saitama, Japan;8. Department of Neurology, Saitama Medical University Hospital, Saitama, Japan;9. Department of Plastic, Reconstructive and Aesthetic Surgery, Saitama Medical University Hospital, Saitama, Japan;10. Department of Infectious Disease and Infection Control, Saitama Medical University Hospital, Saitama, Japan;1. Division of Clinical Microbiology Laboratory, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan;2. Department of Otorhinolaryngology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan;1. Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China;2. Department of Clinical Laboratory Medicine, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi''an, Shaanxi, China;1. Division of Laboratory Medicine, Sapporo Medical University Hospital, Sapporo, Japan;2. Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan;3. Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan;1. Division of Critical Care, Department of Internal Medicine, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey;2. Division of Nephrology, Department of Internal Medicine, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey;3. Department of Anesthesiology and Critical Care, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey;4. Division of Critical Care, Department of Internal Medicine, Medicana Hospital, Izmir, Turkey;5. Department of Pulmonary and Critical Care, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey;1. Department of General Pediatrics, Tokyo Metropolitan Children''s Medical Center, Tokyo, Japan;2. Division of Infectious Diseases, Tokyo Metropolitan Children''s Medical Center, Tokyo, Japan;3. Division of Molecular Laboratory, Tokyo Metropolitan Children''s Medical Center, Tokyo, Japan;4. Clinical Research Support Center, Tokyo Metropolitan Children''s Medical Center, Tokyo, Japan |
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| Abstract: | IntroductionGenetic testing is gaining increasing importance as a part of antimicrobial stewardship (AS). Rapid identification and determination of methicillin susceptibility using the Xpert MRSA/SA BC assay can improve the management of Staphylococcus aureus bacteremia (SAB) and reduce inappropriate antibiotic use. However, few reports have described the effectiveness of this approach.MethodsThe present study aimed to assess the influence of AS using the Xpert MRSA/SA BC assay. Cases were classified into the pre-intervention group (n = 98 patients), in which SAB was identified by traditional culture (November 2017 to November 2019), and the post-intervention group (n = 97 patients), in which the Xpert MRSA/SA BC assay was performed when necessary (December 2019 to December 2021).ResultsPatient characteristics, prognosis, duration of antimicrobial use, and length of hospital stay were compared between the groups. The Xpert assay was performed in 66 patients in the post-intervention group (68.0%). The two groups showed no significant differences in severity and mortality. The rate of cases treated with anti-MRSA agents reduced following the intervention (65.3% vs. 40.4%, p = 0.008). The number of cases involving definitive therapy within 24 h was higher in the post-intervention group (9.2% vs. 24.7%, p = 0.007). The hospitalization rate at >60 days was lower in Xpert implementation cases among MRSA bacteremia cases (28.6% vs. 0%, p = 0.01).ConclusionsThus, the Xpert MRSA/SA BC assay has potential as an AS tool, especially for early definitive treatment to SAB and reduction of long-term hospitalization in MRSA bacteremia cases. |
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| Keywords: | Antimicrobial stewardship Xpert MRSA/SA BC assay |
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