Title

Diagnostic Stewardship: A Clinical Decision Rule for Blood Cultures in Community-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections.

Document Type

Article

Publication Date

2-19-2019

Publication Title

Infect Dis Ther

Abstract

INTRODUCTION: The emergence, spread and persistence of methicillin-resistant Staphylococcus aureus (MRSA) as a causative pathogen in community-onset (CO) skin and soft tissue infections (SSTIs) have resulted in substantial changes in the management of these infections. The indications for obtaining blood cultures in patients with CO-MRSA SSTIs remain poorly defined. The objectives of this study were to derive and validate a clinical decision rule that predicts the probability of MRSA bacteremia in CO-MRSA SSTIs and to identify a low-risk population for whom blood cultures may be safely omitted.

METHODS: This was a retrospective, case-control study with an internal temporal validation cohort conducted at two large urban academic medical centers. Hospitalized adults with CO-MRSA SSTI between 2010 and 2018 were included. Independent predictors of MRSA bacteremia were identified through multivariable logistic regression. A decision rule was derived using weighted coefficient-based scoring. The decision rule was validated in an internal temporal validation cohort.

RESULTS: A total of 307 patients (155 cases and 152 controls) were included in the derivation cohort. A decision rule was created with a "major criterion" defined as purulent cellulitis and "minor criteria" defined as abnormal temperature, intravenous drug use, leukocytosis, tachycardia, body mass index < 25 kg/m

CONCLUSION: The decision rule developed and validated in this study provides a standardized, evidenced-based approach to determine the need for blood cultures based on bacteremia risk.

PubMed ID

30783995

ePublication

ePub ahead of print

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