MRSA Swab Utilization in Children's Hospitals and Their Association with Outcomes

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

With increasing Methicillin resistant Staphylococcus aureus (MRSA) incidence, clinicians must consider the addition of anti-MRSA antibiotics for the treatment of bacterial infections in children. In adult literature, early identification of MRSA using screening swabs has been shown to have high specificity and negative predictive value for MRSA infection. The frequency of MRSA swab use and the implication on clinical outcomes and antimicrobial stewardship in pediatrics is still in question. We aimed to describe the patterns of use of MRSA swabs across children's hospitals and the association with clinical outcomes.

We performed a retrospective cohort study of pediatric hospitalizations of children aged 2 months to 18 years occurring in 2021-2024 and reported to the Pediatric Health Information System (PHIS) database. Patients in an ICU, those with a hematologic/oncologic diagnosis, and stays with incomplete data were excluded. Patients were stratified based on the use of MRSA swab and grouped into diagnosis categories based on the location of their infection. Type, route, and frequency of antibiotic selection were evaluated, along with length of stay, readmission rate, and mortality. Comparisons of outcomes were made between those with and without MRSA swabs using Generalized Estimating Equations to adjust for important patient-level factors and cluster on hospital.

Of 301,155 included encounters, 92.7% did not receive a MRSA screening swab. Of those that did receive a swab, most (58.1%) occurred on the initial day of hospitalization. Interestingly, swabs were utilized most frequently for bone and joint infections (20.6%), where the existing pediatric data evaluating negative predictive value for MRSA is the weakest, and in patients with increasing medical complexity. Patients who received swabs also had a longer length of stay and received more days of intravenous antibiotics compared to those who did not. Readmission rate was similar between groups, as was duration of anti-MRSA antibiotic utilization.

MRSA swabs are well-validated tools in adult literature and are often used to de-escalate antibiotics during inpatient admissions, decreasing exposure to anti-MRSA antibiotics and in some cases, decreasing overall length of hospital stay. Based on our data, MRSA swabs may be inappropriately utilized and/or underutilized for pediatric admissions. More work is needed to validate the test characteristics of swabs in pediatric patients and to identify the scenarios in which swab utilization will provide the most value during pediatric admissions.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1917

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