Utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening in patients with acute myeloid leukemia (AML)

BACKGROUND

Current literature has demonstrated the utility of the MRSA nasal screen as a de-escalation tool to decrease unnecessary anti-MRSA antibiotic therapy. However, data on the applicability of this test in patients with hematologic malignancy is lacking.

METHODS

This is a single-center, retrospective cohort study of patients with acute myeloid leukemia (AML) with or without a history of hematopoietic cell transplant (HCT), with pneumonia and MRSA nasal screening with respiratory cultures obtained. The primary outcome was to determine the negative predictive value (NPV) of the MRSA nasal screen for MRSA pneumonia. Secondary outcomes included sensitivity, specificity, positive predictive value (PPV) of the MRSA nasal screen and prevalence of MRSA pneumonia.

RESULTS

Of 98 patients with AML and pneumonia, the prevalence of MRSA pneumonia was 4.1% with confirmed positive MRSA respiratory cultures observed in 4 patient cases. In patients with confirmed MRSA pneumonia, 3 had positive MRSA nasal screens while 1 had a false negative result, possibly due to a long lag time (21 days) between MRSA nasal screen and pneumonia diagnosis. Overall, the MRSA nasal screen demonstrated 75% sensitivity and 100% specificity, with a PPV of 100% and a NPV of 98.9%.

CONCLUSIONS

Given the low prevalence, empiric use of anti-MRSA therapy in those AML and HCT patients with pneumonia may not be warranted in clinically stable patients. For patients in whom empiric anti-MRSA antibiotics are initiated, nasal screening for MRSA may be utilized to de-escalate anti-MRSA antibiotics in patients with AML with or without HCT.

Engaging Students and Pharmacists in Medical Missions

Medical mission trips help meet the needs of underserved populations in the United States and abroad. As the medication experts, pharmacists play an important role in providing pharmacy services during these trips. Students can serve as pharmacist extenders by applying the knowledge, skills, and values learned in the classroom to reach more patients in resourcelimited settings. This paper describes the experience of the Gregory School of Pharmacy in sponsoring faithbased domestic and international medical missions. We believe that medical missions not only benefit those in need, but also foster professional growth and provide an opportunity for participants to develop a servantleadership mindset. Unlike the traditional leader, the servant-leader shares power, puts the needs of others first, and helps people develop and perform as highly as possible.