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Routine screening for methicillin-resistant Staphylococcus aureus among patients newly admitted to an acute
Farrin A Manian1, Diane Senkel, Jeanne Zack
1Department of Infection Control, St. John's Mercy Medical Center, St. Louis, Missouri, USA.
Background:
Following an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.
Objectives:
To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.
Methods:
Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit
Results:
The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987-1988) to 12% (1999-2000) (P = .0009) for newly admitted patients and from 0% to 7% (P < .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.
Conclusion:
The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) screening at acute rehabilitation units shows increased isolation rates over time. Nares cultures are highly predictive, making perianal cultures less valuable for MRSA detection in this setting.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Public Health
Background:
- An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in 1987 prompted mandatory admission screening for patients in an acute rehabilitation unit.
- Initially, in-house transfers were excluded due to low MRSA colonization prevalence.
Purpose of the Study:
- To profile patients with positive MRSA screening cultures upon admission to an acute rehabilitation unit.
- To assess the diagnostic yield of nares, perianal, and wound cultures for MRSA detection in this population.
Main Methods:
- Prospective chart review.
- Active surveillance for infections within the acute rehabilitation unit.
Main Results:
- MRSA isolation rates significantly increased from 5% (1987-1988) to 12% (1999-2000) for new admissions.
- MRSA isolation rates for in-house transfers rose from 0% to 7%.
- A negative nares culture predicted a negative perianal culture with 98% accuracy; prior MRSA history and external transfers were linked to positive cultures.
Conclusions:
- MRSA isolation rates have significantly increased in acute rehabilitation units over the past decade.
- Perianal cultures offer limited additional value when nares cultures are already obtained in this patient group.