Hospitalist Attending Nicklaus Children's Hospital Miami, Florida, United States
Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections, and empiric treatment in children with complicated pneumonia includes anti-MRSA antibiotics. Adult studies have demonstrated nasal MRSA PCR to have a high negative predictive value, thus serving as a tool to facilitate deescalation of anti-MRSA antibiotics; however pediatric data is limited. Recent studies have demonstrated that in children, the MRSA nasal swab has a specificity of 94% and a NPV of 95% for all sites of infection and can be utilized as an antimicrobial stewardship tool to guide the safe de-escalation of anti-MRSA antibiotics. Objective: We aim to evaluate the clinical outcomes of pediatric patients aged 0 to 18 years old admitted with complicated pneumonia who had a negative MRSA nasal PCR with subsequent deescalation of anti-MRSA antibiotics. The goal is to identify if deescalating MRSA coverage results in a decreased length of stay and decreased cost without requiring escalation of care and without increasing 30-day same-cause readmission as compared to those with a negative MRSA nasal PCR who did not have anti-MRSA antibiotics de-escalated. Design/Methods: This is a retrospective cohort study from 01/01/2018 - 09/01/2024 conducted in a pediatric hospital in Miami, FL. Patients admitted to the medical-surgical floors or the pediatric intensive care unit with an ICD-10 code consistent with complicated pneumonia (J85.0, J85.1, J85.2, J86.0, J86.9, J90.0) or a diagnosis of community-acquired pneumonia (J18.9) in addition to a procedure diagnosis code consistent with pleural drainage were included. Patients admitted to Hematology/Oncology, CICU and NICU, as well as patients with cystic fibrosis, and chronic lung disease were excluded. Study data were collected and managed using REDCap electronic data capture tools hosted at Nicklaus Children's Hospital. This project was deemed as Non-Human Subjects Research by the Nicklaus Children’s Hospital institutional review board.
