{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:51:47Z","timestamp":1793083907057,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia requires empirical therapy coverage for patients with risk factors, yet MRSA causes &amp;lt;1% of community-acquired and 20%\u201340% of nosocomial pneumonias. Methicillin-resistant Staphylococcus aureus polymerase chain reaction (PCR) nasal screening offers rapid results with 95%\u201399% negative predictive value. We systematically evaluated clinical outcomes associated with MRSA nasal screening in hospitalized patients with lower respiratory tract infections (LRTIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed and EMBASE through 29 June 2024 for studies evaluating MRSA nasal screening in adult inpatients with LRTIs. The primary outcome was duration of MRSA therapy. Secondary outcomes included frequency of vancomycin trough monitoring, hospital length of stay, incidence of acute kidney injury (AKI), in-hospital mortality, and 30-day readmission. We performed frequentist and Bayesian meta-analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen studies (2872 patients) were included. Pharmacist-driven protocols (PDP) with PCR versus standard of care significantly reduced MRSA therapy duration (mean difference \u22121.34 days, 95% CI \u22121.59 to \u22121.08; I2 = 61%). Network meta-analysis showed PDP+PCR was most effective (\u22121.51 days versus no testing, 95% CI \u22122.04 to \u2212.98), while PCR or culture alone showed no significant benefit. PDP+PCR reduced vancomycin trough monitoring (OR 0.21, 95% CI .13\u2013.33), AKI (OR 0.54, 95% CI .39\u2013.76), and in-hospital mortality (OR 0.70, 95% CI .50 to .96). Bayesian analysis showed &amp;gt;99% probability of exceeding minimal clinically important differences for duration of MRSA therapy and trough monitoring, but 36% or less for other outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Methicillin-resistant Staphylococcus aureus nasal PCR screening with pharmacist-driven protocols significantly reduces MRSA therapy exposure and improves clinical outcomes in hospitalized LRTI patients, supporting broader implementation of this diagnostic-antimicrobial stewardship synergy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag178","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:40:47Z","timestamp":1774356047000},"source":"Crossref","is-referenced-by-count":2,"title":["Impact of Methicillin-Resistant\n                    <i>Staphylococcus aureus<\/i>\n                    Nasal Screening in Lower Respiratory Tract Infections: A Systematic Review Incorporating Network and Bayesian Meta-Analyses"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4542-6203","authenticated-orcid":false,"given":"Tristan T","family":"Timbrook","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Barnes-Jewish Hospital , Saint Louis, Missouri ,","place":["USA"]},{"name":"Department of Pharmacotherapy, University of Utah College of Pharmacy , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2075-7129","authenticated-orcid":false,"given":"Zijie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy , North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2243-0798","authenticated-orcid":false,"given":"Tamara","family":"Krekel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Barnes-Jewish Hospital , Saint Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"2026041703020508200_ofag178-B1","doi-asserted-by":"crossref","first-page":"e75171","DOI":"10.1371\/journal.pone.0075171","article-title":"Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals","volume":"8","author":"Tadros","year":"2013","journal-title":"PLoS One"},{"key":"2026041703020508200_ofag178-B2","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1186\/s12890-021-01713-1","article-title":"In-hospital mortality associated with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus: a matched-pair cohort study","volume":"21","author":"Sakamoto","year":"2021","journal-title":"BMC Pulm Med"},{"key":"2026041703020508200_ofag178-B3","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1055\/s-0041-1740583","article-title":"Methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia\/ventilator-associated pneumonia","volume":"43","author":"Pickens","year":"2022","journal-title":"Semin Respir Crit Care Med"},{"key":"2026041703020508200_ofag178-B4","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1093\/cid\/ciw300","article-title":"Staphylococcus aureus community-acquired pneumonia: prevalence, clinical characteristics, and outcomes","volume":"63","author":"Self","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026041703020508200_ofag178-B5","doi-asserted-by":"crossref","first-page":"S378","DOI":"10.1086\/533594","article-title":"Pneumonia caused by methicillin-resistant Staphylococcus aureus","volume":"46","author":"Rubinstein","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2026041703020508200_ofag178-B6","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1378\/chest.121.5.1486","article-title":"Applying sputum as a diagnostic tool in pneumonia: limited yield, minimal impact on treatment decisions","volume":"121","author":"Ewig","year":"2002","journal-title":"Chest"},{"key":"2026041703020508200_ofag178-B7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/cid\/ciy024","article-title":"The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications","volume":"67","author":"Parente","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2026041703020508200_ofag178-B8","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2026041703020508200_ofag178-B9"},{"key":"2026041703020508200_ofag178-B10","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/0272989X9101100203","article-title":"The efficacy of diagnostic imaging","volume":"11","author":"Fryback","year":"1991","journal-title":"Med Decis Making"},{"key":"2026041703020508200_ofag178-B11","doi-asserted-by":"crossref","first-page":"2744","DOI":"10.1093\/cid\/ciaa508","article-title":"Molecular testing for acute respiratory tract infections: clinical and diagnostic recommendations from the IDSA's diagnostics committee","volume":"71","author":"Hanson","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026041703020508200_ofag178-B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v093.i06","article-title":"Bayesian Random-effects meta-analysis using the bayesmeta \u00a0R package","volume":"93","author":"R\u00f6ver","year":"2020","journal-title":"J Stat Soft"},{"key":"2026041703020508200_ofag178-B13","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/sim.6381","article-title":"Predictive distributions for between-study heterogeneity and simple methods for their application in Bayesian meta-analysis","volume":"34","author":"Turner","year":"2015","journal-title":"Stat Med"},{"key":"2026041703020508200_ofag178-B14","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1086\/526436","article-title":"Infectious Diseases Society of America emerging infections network. Measuring acceptable treatment failure rates for community-acquired pneumonia: potential for reducing duration of treatment and antimicrobial resistance","volume":"29","author":"Kaye","year":"2008","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026041703020508200_ofag178-B15","volume-title":"Statistical power analysis for the behavioral sciences","author":"Cohen","year":"2009","edition":"2. ed., reprint"},{"key":"2026041703020508200_ofag178-B16","author":"McGrath"},{"key":"2026041703020508200_ofag178-B17","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat Methods Med Res"},{"key":"2026041703020508200_ofag178-B18","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2026041703020508200_ofag178-B19","doi-asserted-by":"crossref","first-page":"11699","DOI":"10.1002\/ece3.6806","article-title":"Consequences of multiple imputation of missing standard deviations and sample sizes in meta-analysis","volume":"10","author":"Kambach","year":"2020","journal-title":"Ecol Evol"},{"key":"2026041703020508200_ofag178-B20","doi-asserted-by":"crossref","first-page":"e02432","DOI":"10.1128\/AAC.02432-16","article-title":"Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR testing reduces the duration of MRSA-targeted therapy in patients with suspected MRSA pneumonia","volume":"61","author":"Baby","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2026041703020508200_ofag178-B21","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/jppr.1770","article-title":"Impact of methicillin-resistant Staphylococcus aureus polymerase chain reaction nasal swabs on vancomycin utilisation in patients admitted to the intensive care unit with respiratory infections","volume":"52","author":"Cho","year":"2022","journal-title":"J Pharm Pract Res"},{"key":"2026041703020508200_ofag178-B22","first-page":"e6378","article-title":"Impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus polymerase chain reaction nasal swab protocol on the De-escalation of empiric vancomycin in patients with pneumonia in a rural healthcare setting","volume":"11","author":"Dadzie","year":"2019","journal-title":"Cureus"},{"key":"2026041703020508200_ofag178-B23","doi-asserted-by":"crossref","first-page":"2236","DOI":"10.1093\/ajhp\/zxab296","article-title":"Effect of rapid methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction screening on vancomycin use in the intensive care unit","volume":"78","author":"Diep","year":"2021","journal-title":"Am J Health Syst Pharm"},{"key":"2026041703020508200_ofag178-B24","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1136\/ejhpharm-2022-003504","article-title":"Antibiotic de-escalation in pneumonia with pharmacist education and ordering of methicillin-resistant Staphylococcus aureus nasal swabs","volume":"31","author":"Doan","year":"2024","journal-title":"Eur J Hosp Pharm"},{"key":"2026041703020508200_ofag178-B25","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1007\/s11096-018-0647-3","article-title":"Evaluation of a pharmacy-driven methicillin-resistant Staphylococcus aureus surveillance protocol in pneumonia","volume":"40","author":"Dunaway","year":"2018","journal-title":"Int J Clin Pharm"},{"key":"2026041703020508200_ofag178-B26","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1093\/cid\/civ495","article-title":"Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR)","volume":"61","author":"Evans","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2026041703020508200_ofag178-B27","first-page":"101","article-title":"Impact of nasal swabs on empiric treatment of respiratory tract infections (INSERT-RTI)","volume":"8","author":"Huffman","year":"2020","journal-title":"Pharmacy (Basel)"},{"key":"2026041703020508200_ofag178-B28","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1177\/10600280221121144","article-title":"Pharmacist-driven methicillin-resistant S. aureus polymerase chain reaction testing for pneumonia","volume":"57","author":"Marinucci","year":"2023","journal-title":"Ann Pharmacother"},{"key":"2026041703020508200_ofag178-B29","doi-asserted-by":"crossref","first-page":"ofab099","DOI":"10.1093\/ofid\/ofab099","article-title":"Discontinuation patterns and cost avoidance of a pharmacist-driven methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction testing protocol for De-escalation of empiric vancomycin for suspected pneumonia","volume":"8","author":"Meng","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026041703020508200_ofag178-B30","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1177\/0018578719888906","article-title":"Impact of a pharmacist-driven MRSA nasal PCR protocol on pneumonia therapy","volume":"56","author":"Pham","year":"2021","journal-title":"Hosp Pharm"},{"key":"2026041703020508200_ofag178-B31","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ajem.2021.01.066","article-title":"Emergency department methicillin-resistant Staphylococcus aureus nare screen effect on pneumonia treatment duration","volume":"44","author":"Renzoni","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2026041703020508200_ofag178-B32","doi-asserted-by":"crossref","first-page":"116134","DOI":"10.1016\/j.diagmicrobio.2023.116134","article-title":"Predictive value of methicillin-resistant staphylococcus aureus nasal swab in patients with COVID-19 pneumonia and secondary bacterial pneumonia","volume":"108","author":"Rowe","year":"2024","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2026041703020508200_ofag178-B33","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ajem.2022.03.009","article-title":"MRSA nasal swab PCR to de-escalate antibiotics in the emergency department","volume":"55","author":"Sindelar","year":"2022","journal-title":"Am J Emerg Med"},{"key":"2026041703020508200_ofag178-B34","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.2146\/ajhp160964","article-title":"Impact of a pharmacist-driven methicillin-resistant Staphylococcus aureus surveillance protocol","volume":"74","author":"Willis","year":"2017","journal-title":"Am J Health Syst Pharm"},{"key":"2026041703020508200_ofag178-B35","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s40265-017-0764-7","article-title":"The whole price of vancomycin: toxicities, troughs, and time","volume":"77","author":"Jeffres","year":"2017","journal-title":"Drugs"},{"key":"2026041703020508200_ofag178-B36","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1093\/cid\/ciae234","article-title":"Rapid diagnostic tests and antimicrobial stewardship programs for the management of bloodstream infection: what is their relative contribution to improving clinical outcomes? A systematic review and network meta-analysis","volume":"79","author":"Peri","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026041703020508200_ofag178-B37","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/cid\/ciw649","article-title":"The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis","volume":"64","author":"Timbrook","year":"2017","journal-title":"Clin Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag178\/67603958\/ofag178.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/4\/ofag178\/68099280\/ofag178.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/4\/ofag178\/68099280\/ofag178.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T07:02:24Z","timestamp":1776409344000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag178\/8551458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag178","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,27]]},"article-number":"ofag178"}}