{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T20:30:56Z","timestamp":1793824256634,"version":"4.6.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Diabetic Foot Infection (DFI) guidelines recommend empiric methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA)-targeted therapy in settings where there is high prevalence of MRSA infections or in cases of severe infection; however, they do not provide recommendations for de-escalation. This approach has the potential to increase unnecessary use of broad-spectrum antibiotics; therefore, additional strategies are needed to optimize appropriate antibiotic use. This study evaluates the effect of MRSA nasal PCR testing on MRSA-targeted antibiotic use and clinical outcomes in patients with DFI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a retrospective quasi-experimental study of patients admitted to South Texas Veterans Health Care System for DFI, with or without osteomyelitis (OM), who had an MRSA nasal PCR and culture data. Eligible patients were identified from the Corporate Data Warehouse and reviewed via electronic health record. Patients were allocated into two groups: PRE (5\/1\/2019-4\/30\/2020) and POST (12\/1\/2020-11\/30\/2021) protocol implementation for de-escalation or avoidance of MRSA-targeted antibiotics. The primary outcome was median (interquartile range [IQR]) hours of empiric inpatient MRSA-targeted antibiotic therapy. A Wilcoxon Rank Sum test was used to assess the difference between the groups for the primary outcome. Secondary outcomes included the proportion of patients needing MRSA coverage added back for MRSA after de-escalation, hospital readmission, length of hospital stay (LOS), patient mortality, and acute kidney injury.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 151 patients were included (83 PRE; 68 POST). Most patients were male (98% PRE; 97% POST) with a median age of 64 (IQR, 56\u201372) years. Incidence of MRSA in DFI in the cohort was 14.7% overall (12% PRE and 17.6% POST). MRSA was detected via nasal PCR in 12% of patients 15.7% PRE and 7.4% POST). After protocol implementation, there was a significant decrease in empiric MRSA-targeted antibiotic therapy use, from a median of 72 (IQR, 27\u2013120) hours in the PRE group, to 24 (IQR, 12\u201372) hours in the POST group (p\u2009&lt;\u20090.01). No significant differences were found for other secondary outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study of patients presenting to a Veterans Affairs (VA) hospital with DFI identified a statistically significant decrease in median duration of MRSA-targeted antibiotic use post-protocol implementation. This suggests a favorable effect of MRSA nasal PCR for de-escalation or avoidance of MRSA-targeted antibiotics in DFI.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-023-08248-2","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T16:01:48Z","timestamp":1683302508000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Clinical utility of methicillin-resistant Staphylococcus aureus nasal PCR to streamline antimicrobial use in treatment of diabetic foot infection with or without osteomyelitis"],"prefix":"10.1186","volume":"23","author":[{"given":"Gaielle","family":"Harb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teri","family":"Hopkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Morneau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Cadena-Zuluaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Frei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"issue":"10","key":"8248_CR1","doi-asserted-by":"publisher","first-page":"e51","DOI":"10.1093\/cid\/ciw118","volume":"62","author":"TF Barlam","year":"2016","unstructured":"Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51\u2013e77.","journal-title":"Clin Infect Dis"},{"key":"8248_CR2","unstructured":"CDC. Antibiotic resistance threats in the United States., 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019."},{"key":"8248_CR3","doi-asserted-by":"crossref","unstructured":"Lipsky BA, Berendt AR, Cornia PB, Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54:e132-e173.","DOI":"10.1093\/cid\/cis346"},{"key":"8248_CR4","doi-asserted-by":"crossref","unstructured":"Lipsky BA, Senniville E, Abbas ZG et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update).Diab Metab Res Rev. 2020:e3280.","DOI":"10.1002\/dmrr.3280"},{"key":"8248_CR5","doi-asserted-by":"publisher","first-page":"3794","DOI":"10.1128\/JCM.01509-06","volume":"44","author":"SJ Drews","year":"2006","unstructured":"Drews SJ, Willey BM, Kreiswirth N, et al. Verification of the IDI-MRSA assay for detecting methicillin-resistant Staphylococcus aureus in diverse specimen types in a core clinical laboratory setting. J Clin Microbiol. 2006;44:3794\u20136.","journal-title":"J Clin Microbiol"},{"key":"8248_CR6","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1128\/AAC.01805-13","volume":"58","author":"B Dangerfield","year":"2014","unstructured":"Dangerfield B, Chung A, Web B, et al. Predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia. Antimicrob Agents Chemother. 2014;58:859\u201364.","journal-title":"Antimicrob Agents Chemother"},{"key":"8248_CR7","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.diagmicrobio.2016.08.011","volume":"86","author":"SE Giancola","year":"2016","unstructured":"Giancola SE, Nguyen AT, Le B, et al. Clinical utility of a nasal swab methicillin-resistant Staphylococcus aureus polymerase chain reaction test in intensive and intermediate care unit patients with pneumonia. Diagn Microbiol Infect Dis. 2016;86:307\u201310.","journal-title":"Diagn Microbiol Infect Dis"},{"key":"8248_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/cid\/ciy024","volume":"67","author":"DM Parente","year":"2018","unstructured":"Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67:1\u20137.","journal-title":"Clin Infect Dis"},{"issue":"4","key":"8248_CR9","doi-asserted-by":"publisher","first-page":"e02432","DOI":"10.1128\/AAC.02432-16","volume":"61","author":"N Baby","year":"2017","unstructured":"Baby N, Faust AC, Smith T, et al. Nasal methicillin-resistant Staphylococcus aureus (MRSA) PCR testing reduces the duration of MRSA-targeted therapy in patients with suspected MRSA pneumonia. Antimicrob Agents Chemother. 2017;61(4):e02432\u201316.","journal-title":"Antimicrob Agents Chemother"},{"key":"8248_CR10","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.diagmicrobio.2014.01.014","volume":"79","author":"A Haleem","year":"2014","unstructured":"Haleem A, Schultz J, Heilmann KP, et al. Concordance of nasal and diabetic foot ulcer staphylococcal colonization. Diagn Microbiol Infect Dis. 2014;79:85\u20139.","journal-title":"Diagn Microbiol Infect Dis"},{"key":"8248_CR11","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1093\/cid\/ciz974","volume":"71","author":"KA Mergenhagen","year":"2020","unstructured":"Mergenhagen KA, Starr KE, Wattengel BA, et al. Determining the utility of methicillin-resistant Staphylococcus aureus nares screening in antimicrobial stewardship. Clin Infect Dis. 2020;71:1142\u20138.","journal-title":"Clin Infect Dis"},{"key":"8248_CR12","doi-asserted-by":"crossref","unstructured":"Brondo J, Morneau K, Hopkins T et al. Correlation between patients with methicillin-resistant staphylococcus aureus (MRSA) nares colonization and MRSA diabetic foot infections.Int J Low Extrem Wounds. 2020;0(0).","DOI":"10.1177\/1534734620963570"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-023-08248-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-023-08248-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-023-08248-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T16:04:23Z","timestamp":1683302663000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-023-08248-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,5]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["8248"],"URL":"https:\/\/doi.org\/10.1186\/s12879-023-08248-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,5]]},"assertion":[{"value":"14 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The University of Texas Health at San Antonio Institutional Review Board (San Antonio, TX, USA) conducted a review through the Office of Clinical Research. The study was approved under non-regulated research, was exempt from Institutional Review Board review, and classified as quality improvement. It was a retrospective chart review of an intervention that had already been made under our local antimicrobial stewardship program as quality improvement, as such informed consent was waived by the University of Texas Health at San Antonio Institutional Review Board (San Antonio, TX, USA) because this intervention was not made under a research protocol. All methods were performed in accordance with the institution relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"297"}}