Do you add empiric anti-MRSA coverage to the initial antibiotic regimen for a patient admitted with community-acquired pneumonia who has risk factors for MRSA but a negative MRSA nasal screen?

Thank you for this excellent and highly relevant clinical question. I approach this scenario by blending robust evidence-based medicine with fundamental principles of diagnostic reasoning. The short answer is generally no, you probably do not need to add empiric anti-MRSA coverage for a standard CAP admission with a negative screen.

However, there are critical exceptions where pre-test probability overrides the negative test result. Let me walk you through the data and the diagnostic reasoning behind this. To answer your question, we must look at the landmark 2018 diagnostic meta-analysis by Parente et al., PMID 29340593. This comprehensive analysis pooled 22 studies encompassing over 5,100 patients to evaluate the clinical utility of MRSA n...

Yes.