Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-29T02:33:06.274Z Has data issue: false hasContentIssue false
  • English
  • Français

Value of Performing Active Surveillance Cultures on Intensive Care Unit Discharge for Detection of Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Jon P. Furuno ,
Anthony D. Harris ,
Marc-Oliver Wright ,
David M. Hartley ,
Jessina C. McGregor ,
Holly D. Gaff ,
Joan N. Hebden ,
Harold C. Standiford  and
Eli N. Perencevich
Jon P. Furuno*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Infection Control and Hospital Epidemiology, University of Maryland Medical Center, Baltimore, Maryland
Marc-Oliver Wright
Affiliation:
Marshfleld Clinic Research Foundation, Marshfield Epidemiology Research Center, Marshfield, Wisconsin
David M. Hartley
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Jessina C. McGregor
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Department of Pharmacy Practice, College of Pharmacy, Oregon State University, Portland
Holly D. Gaff
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Joan N. Hebden
Affiliation:
Infection Control and Hospital Epidemiology, University of Maryland Medical Center, Baltimore, Maryland
Harold C. Standiford
Affiliation:
Infection Control and Hospital Epidemiology, University of Maryland Medical Center, Baltimore, Maryland
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
*
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 100 North Greene Street, Lower Level, Baltimore, MD 21201 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To quantify the value of performing active surveillance cultures for detection of methicillin-resistant Staphylococcus aureus (MRSA) on intensive care unit (ICU) discharge.

Design.

Prospective cohort study.

Setting.

Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.

Participants.

We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.

Results.

Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.

Conclusions.

Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 666 - 670
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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.Google Scholar
2.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.Google Scholar
3.Marshall, C, Wolfe, R, Kossmann, T, Wesselingh, S, Harrington, G, Spelman, D. Risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by trauma patients in the intensive care unit. J Hosp Infect 2004;57:245–252.Google Scholar
4.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.Google Scholar
5.Fishbain, JT, Lee, JC, Nguyen, HD, et al.Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol 2003;24:415–421.Google Scholar
6.Muto, CA, Jernigan, IA, 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.Google Scholar
7.Furuno, JP, Perencevich, EN, Johnson, JA, et al.Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization. Emerg Infect Dis 2005;11:1539–1544.Google Scholar
8.Harris, AD, Nemoy, L, Johnson, JA, et al.Co-carriage rates of vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase-producing bacteria among a cohort of intensive care unit patients: implications for an active surveillance program. Infect Control Hosp Epidemiol 2004;25:105–108.Google Scholar
9.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;32:436–440.Google Scholar
10.Furuno, JP, McGregor, JC, Harris, AD, et al.Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166:580–585.Google Scholar
11.McGregor, JC, Kim, PW, Perencevich, EN, et al.Utility of the Chronic Disease Score and Charlson Comorbidity Index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol 2005;161:483–493.Google Scholar
12.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar
13.Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995;21:1417–1423.Google Scholar
14.Lodise, TP, McKinnon, PS, Swiderski, L, Rybak, MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis 2003;36:1418–1423.Google Scholar
15.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.CrossRefGoogle ScholarPubMed