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Life sciences · Journal article
Journal of the Pediatric Infectious Diseases Society · September 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This retrospective single-center study evaluated MRSAP diagnostic performance in 243 pediatric S. aureus infections and found suboptimal sensitivity (42.9%) and insufficient negative predictive value for safe de-escalation of empiric MRSA coverage. The small MRSA sample (n=7), low screening utilization (46.2%), and predominance of skin/soft tissue infections limit generalizability and clinical applicability.
Retrospective cohort study. Pediatric patients with microbiologically confirmed S. aureus infections in inpatient and outpatient settings at Loyola University Medical Center. Excluded: premature infants, patients screened for surveillance purposes only, immunocompromised patients, and inpatients not treated with antibiotics.. Intervention: MRSA nasal PCR screening (MRSAP). Compared with: Subsequent culture and susceptibility testing for confirmation of MRSA or MSSA infection. n = 243. Single center: Loyola University Medical Center, Maywood, Illinois, USA.
MRSA accounted for 15.64% (38/243) of all S. aureus infections; 69.5% were skin and soft tissue infections MRSAP sensitivity was 42.9% (95% CI: 9.9%–81.6%), specificity 94.3% (95% CI: 80.1%–99.3%), NPV 89.2% (95% CI: 74.6%–97.0%) Among inpatient MRSA cases, 58.82% received empiric vancomycin; 31.1% of MSSA cases also received vancomycin (p=0.37 for screening status effect)
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The suboptimal sensitivity and wide confidence intervals for MRSAP do not support its use for guiding empiric de-escalation of MRSA coverage in pediatric practice at this institution. Clinicians should not rely on negative MRSAP results to exclude MRSA coverage empirically, and prospective validation in larger pediatric cohorts is needed before implementation.
Single-center retrospective cohort with suboptimal diagnostic performance (42.9% sensitivity), small MRSA sample size (n=7), and acknowledged limitations that preclude clinical decision-making; suggests need for larger prospective work.
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The suboptimal sensitivity and wide confidence intervals for MRSAP do not support its use for guiding empiric de-escalation of MRSA coverage in pediatric practice at this institution. Clinicians should not rely on negative MRSAP results to exclude MRSA coverage empirically, and prospective validation in larger pediatric cohorts is needed before implementation.
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Abstract Corresponding Author Ban AL-Sayyed, MD, Department of Pediatrics, Division of Infectious Diseases, Loyola University Hospital & Medical Center, Maywood, IL, 309-713-5363, ban.al-sayyed@lumc.edu Funding No funding to report. Conflict(s) of Interest No conflict of interest for any of the authors. Background Methicillin-resistant Staphylococcus aureus nasal PCR screening (MRSAP) has demonstrated utility in antimicrobial stewardship for adult populations; however, its performance in pediatric patients remains incompletely characterized. We evaluated the diagnostic performance and clinical impact of MRSAP screening in pediatric S. aureus infections. Methods We conducted a retrospective cohort study of 243 pediatric patients with microbiologically confirmed Staphylococcus aureus infections treated in inpatient and outpatient settings at Loyola University Medical Center between January 1, 2021, and April 30, 2024. Patients were excluded if they were premature, underwent MRSAP for surveillance purposes, were immunocompromised, or were inpatients not treated with antibiotics. We assessed MRSAP utilization among admitted infected patients, calculated diagnostic performance of PCR for predicting MRSA infection, and analyzed empiric antibiotic prescribing patterns in relation to PCR results. Results MRSA accounted for 15.64% (38/243) of infections, with skin and soft tissue infections comprising 69.5% of cases. MRSAP was performed in 46.2% (42/91) of inpatient admissions. Among screened patients, MRSAP sensitivity was 42.9% (95% CI: 9.9%-81.6%), specificity 94.3% (95% CI: 80.1%-99.3%), positive predictive value 60.0% (95% CI: 14.7%-94.7%), and negative predictive value 89.2% (95% CI: 74.6%-97.0%). Among inpatient MRSA cases, 58.82% received empiric vancomycin, while 31.1% of MSSA cases also received empiric vancomycin. Screening status did not significantly influence empiric vancomycin prescribing (p=0.37), although positive screens were associated with increased vancomycin use when results were utilized (80% vs. 29.73%, p=0.05). All MRSA isolates were 100% susceptible to vancomycin, and clindamycin susceptibility was 64.71% for inpatient MRSA and 85.71% for outpatient MRSA. Conclusions MRSAP screening demonstrated suboptimal diagnostic performance in this pediatric cohort, with sensitivity and negative predictive value insufficient for confident de-escalation of empiric MRSA coverage. The predominance of skin and soft tissue infections, low screening utilization (46.15%), and small MRSA sample size (n=7) likely contributed to poor test performance. These findings suggest limited utility of MRSAP for guiding empiric antibiotic therapy in pediatric S. aureus infections at our institution, particularly for skin and soft tissue infections. Prospective studies with standardized screening and larger cohorts are needed to optimize antimicrobial stewardship strategies in pediatric populations.
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