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Comparison of Polymerase Chain Reaction (PCR) vs. Culture-Based Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screenings on Time to Vancomycin De-escalation during Pneumonia Treatment
Monday May 18, 2026 11:20am - 11:40am EDT
a.Pavilion Hub WEST
Purpose: To compare the impact of polymerase chain reaction (PCR)-based and culture-based methicillin-resistant Staphylococcus aureus (MRSA) nasal swab testing on time to vancomycin de-escalation, test turnaround time, and cost-effectiveness.  
Methods: A multi-center, retrospective, observational pre-/post-implementation cohort study was conducted within two community hospitals in a large academic health system. The study evaluated hospitalized adults receiving empiric intravenous vancomycin for suspected pneumonia during March 1st to August 1st, 2024 (culture-based MRSA screening) and March 1st to August 1st, 2025 (MRSA nasal PCR screening). The primary outcome was time from MRSA screening test collection to vancomycin discontinuation. Secondary outcomes included test turnaround time, total vancomycin days of therapy, proportion of patients de-escalated within 36 hours, and rate of reinitiation of MRSA therapy during the admission. A cost analysis was also conducted.  
Results: Implementation of MRSA PCR testing significantly reduced the time from screening collection to vancomycin discontinuation. Median time decreased from 34.9 hours (IQR 25.8–51.0) pre-implementation to 18.8 hours (IQR 9.7–36.2) post-implementation (p < 0.001). Turnaround time was also significantly shorter with PCR (4.9 vs 28.3 hours, p < 0.001). While median total vancomycin days of therapy remained 2.0 days in both groups, the difference was still statistically significant (p = 0.004). De-escalation within 36 hours was numerically higher post-implementation (68% vs 51%, p = 0.132). 
Conclusions: Implementation of MRSA nasal PCR screening was associated with significantly faster test turnaround time and earlier discontinuation of vancomycin compared with culture-based screening. These findings support the use of rapid molecular diagnostics as a valuable tool in antimicrobial stewardship in the aim of timely de-escalation of empiric anti-MRSA therapy in patients with suspected or confirmed pneumonia.
Moderators
AM
DM
EM
Speakers
AN

Anna Nahirnyak

PGY1, Jefferson Abington Hospital
I am from Feasterville, Pennsylvania, and graduated from the Philadelphia College of Pharmacy. I am currently completing my PGY1 residency at Jefferson Abington Hospital and will be staying on for a second year to pursue a PGY2 in infectious diseases. My long-term goal is to become... Read More →
Monday May 18, 2026 11:20am - 11:40am EDT
a.Pavilion Hub WEST
  Infectious Diseases

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