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Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-Resistant Staphylococcus aureus Colonization at the Time of Hospital or Intensive Care Unit Admission

Published online by Cambridge University Press:  02 January 2015

James A. McKinnell ,
Susan S. Huang ,
Samantha J. Eells ,
Eric Cui  and
Loren G. Miller
James A. McKinnell*
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California Torrance Memorial Medical Center, Torrance, California
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine, California
Samantha J. Eells
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
Eric Cui
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine, California
Loren G. Miller
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
*
1124 West Carson Street, Box 466, Torrance, CA 90502 ([email protected])
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Abstract

Objective.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and intensive care unit (ICU) admission in many states. However, MRSA colonization at extranasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extranasal testing for MRSA.

Design.

We searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extranasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs and those admitted to hospitals with a high prevalence (6% or greater) or low prevalence (less than 6%) of MRSA carriers. Data were extracted using a standardized instrument.

Results.

We reviewed 4,381 abstracts and 735 articles. Twenty-three articles met the criteria for analysis (n = 39,479 patients). Extranasal MRSA screening increased the yield by approximately one-third over nares alone. The yield was similar at ICU admission (weighted average, 33%; range, 9%–69%) and hospital admission in high-prevalence (weighted average, 37%; range, 9%–86%) and low-prevalence (weighted average, 50%; range, 0%–150%) populations. For comparisons between individual extranasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum, by 20%; wounds, by 17%; and axilla, by 7%.

Conclusions.

Extranasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared with nares screening alone. Findings were consistent among subpopulations examined. Extranasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 161 - 170
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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