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Electronic Prediction Rules for Methicillin-Resistant Staphylococcus aureus Colonization

Published online by Cambridge University Press:  02 January 2015

Ari Robicsek ,
Jennifer L. Beaumont ,
Marc-Oliver Wright ,
Richard B. Thomson Jr ,
Karen L. Kaul  and
Lance R. Peterson
Ari Robicsek*
Affiliation:
University of Chicago Pritzker School of Medicine, Chicago, Illinois NorthShore University Health System, Departments of Medicine, Chicago, Illinois Medical Informatics, Chicago, Illinois Infection Control, Chicago, Illinois Center for Clinical Research Informatics, Chicago, Illinois
Jennifer L. Beaumont
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Marc-Oliver Wright
Affiliation:
Infection Control, Chicago, Illinois
Richard B. Thomson Jr
Affiliation:
University of Chicago Pritzker School of Medicine, Chicago, Illinois Pathology and Laboratory Medicine, Chicago, Illinois
Karen L. Kaul
Affiliation:
University of Chicago Pritzker School of Medicine, Chicago, Illinois Pathology and Laboratory Medicine, Chicago, Illinois
Lance R. Peterson
Affiliation:
University of Chicago Pritzker School of Medicine, Chicago, Illinois Pathology and Laboratory Medicine, Chicago, Illinois Infection Control, Chicago, Illinois
*
NorthShore University HealthSystem, 2650 Ridge Avenue, Burch 124, Evanston, IL 60201 ([email protected])
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Abstract

Background.

Considerable hospital resources are dedicated to minimizing the number of methicillin-resistant Staphylococcus aureus (MRSA) infections. One tool that is commonly used to achieve this goal is surveillance for MRSA colonization. This process is costly, and false-positive test results lead to isolation of individuals who do not carry MRSA. The performance of this technique would improve if patients who are at high risk of colonization could be readily targeted.

Methods.

Five MRSA colonization prediction rules of varying complexity were derived in a population of 23,314 patients who were consecutively admitted to a US hospital and tested for colonization. Rules incorporated only prospectively collected, structured electronic data found in a patient's record within 1 day of hospital admission. These rules were tested in a validation cohort of 26,650 patients who were admitted to 2 other hospitals.

Results.

The prevalence of MRSA at hospital admission was 2.2% and 4.0% in the derivation and validation cohorts, respectively. Multivariable modeling identified predictors of MRSA colonization among demographic, admission-related, pharmacologic, laboratory, physiologic, and historical variables. Five prediction rules varied in their performance, but each could be used to identify the 30% of patients who accounted for greater than 60% of all cases of MRSA colonization and approximately 70% of all MRSA-associated patient-days. Most rules could also identify the 20% of patients with a greater than 8% chance of colonization and the 40% of patients among whom colonization prevalence was 2% or less.

Conclusions.

We report electronic prediction rules that can fully automate triage of patients for MRSA-related hospital admission testing and that offer significant improvements on previously reported rules. The efficiencies introduced may result in savings to infection control programs with little sacrifice in effectiveness.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 9 - 19
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409–418.CrossRefGoogle ScholarPubMed
2. Veterans Health Administration Directive 2007-002. http://www.pittsburgh.va.gov/MRSA/MRSA_Prevention_Initiative.asp. Accessed April 9, 2010.Google Scholar
3.Coia, JE, Duckworth, GJ, Edwards, DI, et al. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(suppl 1):S1–S44.CrossRefGoogle ScholarPubMed
4.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(5):362–386.Google Scholar
5.Calfee, DP, Salgado, CD, Classen, D, et al. Strategies to prevent trans-mission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S62–S80.Google Scholar
6.Siegel, JD, Rhinehart, E, Jackson, M, Chairello, L; the Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed April 9, 2010.Google Scholar
7. MRSA screening- operational guidance—Department of Health, 2009. http://www.dh.gov.Uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_086682.pdf. Accessed April 9, 2010.Google Scholar
8. Illinois SB 233, 2007. http://12.43.67.2/legislation/publicacts/fulltext.asp?Name =095-0312. Accessed April 9, 2010.Google Scholar
9. Pennsylvania HB 700, 2007. http://www.gohcr.state.pa.us/prescription-for-pennsylvania/HOUSEBILL700P_N_1011.htm. Accessed April 9, 2010.Google Scholar
10. New Jersey S2580, 2007. http://www.njleg.state.nj.us/2006/Bills/S3000/2580_I1.HTM. Accessed April 9, 2010.Google Scholar
11.Hidron, Al, Kourbatova, EV, Halvosa, JS, et al. Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 2005;41(2):159–166.Google Scholar
12.Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24(6):409–414.Google Scholar
13.Troillet, N, Carmeli, Y, Samore, MH, et al. Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19(3):181–185.Google Scholar
14.Casas, I, Sopena, N, Esteve, M, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus carriage at hospital admission. Infect Control Hosp Epidemiol 2007;28(11):1314–1317.Google Scholar
15.Lucet, JC, Chevret, 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. Arch Intern Med 2003;163(2):181–188.Google Scholar
16.Morange-Saussier, V, Giraudeau, B, van der Mee, N, Lermusiaux, P, Quentin, R. Nasal carriage of methicillin-resistant Staphylococcus aureus in vascular surgery. Ann Vase Surg 2006;20(6):767–72.Google Scholar
17.Graham, PL III, Lin, SX, Larson, EL. A US population-based survey of Staphylococcus aureus colonization. Ann Intern Med 2006;144(5):318–325.Google Scholar
18.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9):1226–1234.Google Scholar
19.Rim, JY, Bacon, AE III. Prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in a random sample of healthy individuals. Infect Control Hosp Epidemiol 2007;28(9):1044–1046.Google Scholar
20.Harbarth, S, Sax, H, Fankhauser-Rodriguez, C, Schrenzel, J, Agostinho, A, Pittet, D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 2006;119(3):e15–e23.Google Scholar
21.Furuno, JP, Harris, AD, Wright, MO, et al. Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission. Am J Infect Control 2004;32(8):436–440.Google Scholar
22.Furuno, JP, McGregor, JC, Harris, AD, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166(5):580–585.Google Scholar
23.Harbarth, S, Sax, H, Uckay, I, et al. A predictive model for identifying surgical patients at risk of methicillin-resistant Staphylococcus aureus carriage on admission. J Am Coll Surg 2008;207(5):683–689.Google Scholar
24.Haley, CC, Mittal, D, Laviolette, A, Jannapureddy, S, Parvez, N, Haley, RW. Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing. J Clin Microbiol 2007;45(9):3031–3038.CrossRefGoogle ScholarPubMed
25.Riedel, S, Von, SD, Richardson, K, et al. Development of a prediction rule for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus carriage in a Veterans Affairs Medical Center population. Infect Control Hosp Epidemiol 2008;29(10):969–971.CrossRefGoogle Scholar
26.Kupferwasser, LI, Yeaman, MR, Nast, CC, et al. Salicylic acid attenuates virulence in endovascular infections by targeting global regulatory pathways in Staphylococcus aureus. J Clin Invest 2003;112(2):222–233.Google Scholar
27.Muller, E, Al-Attar, J, Wolff, AG, Farber, BF. Mechanism of salicylate-mediated inhibition of biofilm in Staphylococcus epidermidis. J Infect Dis 1998;177(2):501–503.Google Scholar
28.Paule, SM, Pasquariello, AC, Thomson, RB Jr, Kaul, KL, Peterson, LR. Real-time PCR can rapidly detect methicillin-susceptible and methicillin-resistant Staphylococcus aureus directly from positive blood culture bottles. Am J Clin Pathol 2005;124(3):404–407.Google Scholar
29.Leonard, RB, Mayer, J, Sasser, M, et al. Comparison of MIDI Sherlock system and pulsed-field gel electrophoresis in characterizing strains of methicillin-resistant Staphylococcus aureus from a recent hospital out-break. J Clin Microbiol 1995;33(10):2723–2727.CrossRefGoogle Scholar
30.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33(9):2233–2239.Google Scholar
31.Klevens, RM, Morrison, MA, Nadle, I, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298(15):1763–1771.CrossRefGoogle ScholarPubMed
32.DeLong, ER, DeLong, DM, Clarke-Pearson, DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44(3):837–845.Google Scholar
33.Wasson, JH, Sox, HC, Neff, RK, Goldman, L. Clinical prediction rules: applications and methodological standards. N Engl J Med 1985;313(13): 793–799.Google Scholar
34.Buchsbaum, DG, Buchanan, RG, Centor, RM, Schnoll, SH, Lawton, MJ. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med 1991;115(10):774–777.Google Scholar
35.Wells, PS, Ginsberg, JS, Anderson, DR, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129(12):997–1005.Google Scholar
36.Landefeld, CS, Goldman, L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med 1989;87(2):144–152.CrossRefGoogle ScholarPubMed
37.Stiell, IG, Greenberg, GH, McKnight, RD, et al. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA 1993;269(9):1127–1132.Google Scholar
38.Kucher, N, Koo, S, Quiroz, R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005;352(10):969–977.Google Scholar
39.van Wyk, JT, van Wijk, MA, Sturkenboom, MC, Mosseveld, M, Moorman, PW, van der Lei, J. Electronic alerts versus on-demand decision support to improve dyslipidemia treatment: a cluster-randomized controlled trial. Circulation 2008;117(3):371–378.Google Scholar
40.Evans, RS, Wallace, CJ, Lloyd, JF, et al. Rapid identification of hospitalized patients at high risk for MRSA carriage. J Am Med Inform Assoc 2008; 15(4):506–512.Google Scholar
41.Vandenbroucke-Grauls, CM. Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 1996;17(8):512–513.Google Scholar
42.Paule, SM, Hacek, D, Kufner, B, et al. Performance of the BD GeneOhm methicillin-resistant Staphylococcus aureus test before and during high-volume clinical use. J Clin Microbiol 2007;45(9):2993–2998.Google Scholar
43.Weber, DJ, Hoffmann, KK, Rutala, WA, Pyatt, DG. Control of healthcare-associated Staphylococcus aureus: survey of practices in North Carolina hospitals. Infect Control Hosp Epidemiol 2009;30(9):909–911.Google Scholar