Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T07:10:49.881Z Has data issue: false hasContentIssue false
  • English
  • Français

What Proportion of Hospital Patients Colonized With Methicillin-Resistant Staphylococcus aureus Are Identified by Clinical Microbiological Cultures?

Published online by Cambridge University Press:  21 June 2016

Cassandra D. Salgado  and
Barry M. Farr
Cassandra D. Salgado*
Affiliation:
Medical University of South Carolina, Charleston, Charlottesville
Barry M. Farr
Affiliation:
University of Virginia Health System, Charlottesville
*
Division of Infectious Diseases, Medical University of South Carolina, 100 Doughty Street, Suite 210 IOP South, Charleston, SC 29425 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Most hospitals in the United States do not perform active surveillance cultures and, thus, rely on clinical microbiological cultures (CMCs) to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA). We sought to determine what proportion of patients who are colonized with MRSA at admission are identified by CMCs during hospitalization.

Methods.

From February 1998 through November 2002, patients found to be colonized with MRSA at admission by use of active surveillance cultures were identified. The proportion of colonized patients who had a CMC that was positive for MRSA, the number of CMCs performed and their type (ie, according to the anatomical site from which specimens were obtained for culture), and the number and type of CMCs that were positive for MRSA were calculated.

Results.

Four hundred thirty-seven patients were found to be colonized with MRSA at admission, and 98 of 1,238 CMCs (7.9%; 95% confidence interval, 6.5%-9.6%) performed for 66 of these patients (15%; 95% confidence interval, 11.9%-18.8%) were positive for MRSA. The number of nonisolated days that would have occurred by relying on CMCs to identify MRSA-colonized patients was 3,247 (mean, 7.4 days per patient). Among the anatomical sites from which specimens were obtained for CMC, wounds demonstrated the highest sensitivity (30.2%) for identifying MRSA-colonized patients.

Conclusions.

CMCs failed to identify 85% of MRSA-colonized patients, because, in part, CMCs identified only a small proportion of colonized patients. Because many studies have shown a decrease in the transmission of MRSA from colonized patients for whom contact precautions, rather than standard precautions, are used, the findings of this study suggest that failure to identify colonized patients and to use contact precautions may be an important reason for the increasing rate of nosocomial MRSA infection in hospitals in the United States.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 2 , February 2006 , pp. 116 - 121
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a metaanalysis. Clin Infect Dis 2003; 36:53–59.CrossRefGoogle ScholarPubMed
2.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003; 36:592–598.CrossRefGoogle ScholarPubMed
3.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999; 20:408–411.CrossRefGoogle ScholarPubMed
4.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470–485.CrossRefGoogle Scholar
5.Garner, JS. Guideline for isolation precautions in hospitals. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996; 17:53–80.CrossRefGoogle ScholarPubMed
6.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003; 24:362–386.CrossRefGoogle ScholarPubMed
7.Kloos, W, Bannerman, T. Staphylococcus and Micrococcus. In: Murray, P, Baron, E, Pfaller, M, Tenover, F, Yolken, R, eds. Manual of Clinical Microbiology. Washington, D.C.: ASM Press; 1999:264–282.Google Scholar
8.National Committee for Clinical Laboratory Standards (NCCLS). Performance Standard for Antimicrobial Disk Susceptibility Tests. Approved standard M2-A7. Wayne, PA: NCCLS; 2000.Google Scholar
9.Merrer, J, Santoli, F, Appere de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000; 21:718–723.CrossRefGoogle Scholar
10.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003; 36:281–285.CrossRefGoogle ScholarPubMed
11.Garrouste-Orgeas, M, Timsit, JF, Kallel, H, et al. Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 2001; 22:687–692.CrossRefGoogle ScholarPubMed
12.Haley, RW, Cushion, NB, Tenover, FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995; 171:614–624.CrossRefGoogle ScholarPubMed
13.Jernigan, JA, Titus, MG, Groschel, DHM, Getchell-White, SI, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996; 143:496–504.CrossRefGoogle ScholarPubMed
14.Vriens, MR, Fluit, AC, Troelstra, A, Verhoef, J, Van Der Werken, C. Is methicillin-resistant Staphylococcus aureus more contagious than methicillin-sensitive S. aureus in a surgical intensive care unit? Infect Control Hosp Epidemiol 2002; 23:491–494.CrossRefGoogle Scholar
15.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97:309–317.CrossRefGoogle ScholarPubMed
16.Verhoef, J, Beaujean, D, Blok, H, et al. A Dutch approach to methicillin resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999; 18: 461–466.CrossRefGoogle ScholarPubMed
17.Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995; 16:686–696.CrossRefGoogle Scholar
18.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999; 282:1745–1751.CrossRefGoogle Scholar
19.Jans, B, Suetens, C, Struelens, M. Decreasing MRSA rates in Belgian hospitals: results from the national surveillance network after introduction of national guidelines. Infect Control Hosp Epidemiol 2000; 21:419.Google Scholar
20.Harbarth, S, Martin, Y, Rohner, P, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2000; 46:43–49.CrossRefGoogle ScholarPubMed
21.Back, NA, Linnemann, CC Jr, Staneck, JL, Kotagal, UR. Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit: use of intensive microbiologic surveillance and mupirocin. Infect Control Hosp Epidemiol 1996; 17:227–231.Google Scholar
22.Murray-Leisure, KA, Geib, S, Graceley, D, et al. Control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1990; 11:343–350.CrossRefGoogle ScholarPubMed
23.Nicolle, LE, Dyck, B, Thompson, G, et al. Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1999; 20:202–205.CrossRefGoogle ScholarPubMed
24.Kotilainen, P, Routamaa, M, Peltonen, R, et al. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch intern Med 2001; 161:859–863.CrossRefGoogle Scholar
25.Lucet, JC, Chevert, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Multicenter Study Group. Arch Intern Med 2003; 163:181–188.CrossRefGoogle Scholar
26.Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998; 27:543–550.CrossRefGoogle ScholarPubMed
27.Boyce, JM, Havill, NL, Kohan, C, Dumigan, DG, Ligri, CE. Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2004; 25:395–401.CrossRefGoogle ScholarPubMed
28.Nijssen, S, Bonten, JM, Weinstein, RA. Are active surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 2005; 40:405–409.CrossRefGoogle ScholarPubMed
29.Cepeda, JA, Whitehouse, T, Cooper, B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005; 365:295–304.CrossRefGoogle ScholarPubMed
30.Pan, A, Carnevale, G, Catenazzi, P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA “search and isolate” strategy in a hospital in Italy with hyperendemic MRSA. Infect Control Hosp Epidemiol 2005; 26:127–133.CrossRefGoogle Scholar
31.Blank, MK, Haas, L, Donahoe, M, Stuart, S, Kramer, P, Muto, CA. Active methicillin-resistant Staphylococcus aureus (MRSA) surveillance cultures and the effect in reducing MRSA nosocomial infections. Paper presented at: 14th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 17-20, 2004; Philadelphia, PA. Abstract 39.Google Scholar
32.Salgado, CD, Nobles, DL, Ruisz, MS, Christie, JD, Catrou, PG, Kerkering, TM, Engel, JP. Control of nosocomial methicillin-resistant Staphylococcus aureus using active surveillance cultures and contact precautions. Paper presented at: 14th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 17-20, 2004; Philadelphia, PA. Abstract 4.Google Scholar
33.Sunenshine, RH, Liedtke, LA, Fridkin, SK, Strausbaugh, LJ. Management of inpatients colonized or infected with antimicrobial-resistant bacteria in hospitals in the United States. The Infectious Diseases Society of America Emerging Infections Network. Infect Control Hosp Epidemiol 2005;26:138–143.CrossRefGoogle ScholarPubMed
34.Esveld, MI, de Boer, AS, Notenboom, AJ, van Pelt, W, van Leeuwen, WJ. Secondary infection with methicillin-resistant Staphylococcus aureus in Dutch hospitals (July 1997-June 1996). Nederlands Tijdschrift voor Geneeskunde 1999; 143:205–208.Google ScholarPubMed
35.Marshall, C, Harrington, G, Wolfe, R, Fairley, CK, Wesselingh, S, Spelman, D. Acquisition of methicillin-resistant Staphylococcus aureus in a large intensive care unit. Infect Control Hosp Epidemiol 2003; 24:322–326.CrossRefGoogle Scholar
36.Lucet, JC, Grenet, K, Armond-Lefevre, L, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005; 26:121–126.CrossRefGoogle ScholarPubMed