Active Surveillance for Methicillin-Resistant Staphylococcus aureus(MRSA) Decreases the Incidence of MRSA Bacteremia

2006 ◽  
Vol 27 (10) ◽  
pp. 1004-1008 ◽  
Author(s):  
Pnina Shitrit ◽  
Bat-Sheva Gottesman ◽  
Michal Katzir ◽  
Avi Kilman ◽  
Yona Ben-Nissan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
High Risk ◽  
Active Surveillance ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
Contact Isolation ◽  
Surveillance Cultures ◽  
The Mean ◽  
Positive Results

Objectives.To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital.Design.Before-after trial.Setting.A 700-bed hospital.Patients.All patients admitted to the hospital who were at high risk for MRSA bacteremia.Intervention.Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004).Results.The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (P<.001). The mean number of MRSA bacteremia cases per month decreased from 3.6 cases before the intervention to 1.8 cases after the intervention (P< 0.001).Conclusions.Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.

scholarly journals Targeted Surveillance of Methicillin-Resistant Staphylococcus aureus and Its Potential Use To Guide Empiric Antibiotic Therapy

2010 ◽  
Vol 54 (8) ◽  
pp. 3143-3148 ◽  
Author(s):  
Anthony D. Harris ◽  
Jon P. Furuno ◽  
Mary-Claire Roghmann ◽  
Jennifer K. Johnson ◽  
Laurie J. Conway ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
High Risk ◽  
Antibiotic Therapy ◽  
Active Surveillance ◽  
Empiric Antibiotic Therapy ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
Clinical Culture ◽  
Empiric Antibiotic ◽  
Mrsa Colonization

ABSTRACT The present study aimed to determine the frequency of methicillin-resistant Staphylococcus aureus (MRSA)-positive clinical culture among hospitalized adults in different risk categories of a targeted MRSA active surveillance screening program and to assess the utility of screening in guiding empiric antibiotic therapy. We completed a prospective cohort study in which all adults admitted to non-intensive-care-unit locations who had no history of MRSA colonization or infection received targeted screening for MRSA colonization upon hospital admission. Anterior nares swab specimens were obtained from all high-risk patients, defined as those who self-reported admission to a health care facility within the previous 12 months or who had an active skin infection on admission. Data were analyzed for the subcohort of patients in whom an infection was suspected, determined by (i) receipt of antibiotics within 48 h of admission and/or (ii) the result of culture of a sample for clinical analysis (clinical culture) obtained within 48 h of admission. Overall, 29,978 patients were screened and 12,080 patients had suspected infections. A total of 46.4% were deemed to be at high risk on the basis of the definition presented above, and 11.1% of these were MRSA screening positive (colonized). Among the screening-positive patients, 23.8% had a sample positive for MRSA by clinical culture. Only 2.4% of patients deemed to be at high risk but found to be screening negative had a sample positive for MRSA by clinical culture, and 1.6% of patients deemed to be at low risk had a sample positive for MRSA by clinical culture. The risk of MRSA infection was far higher in those who were deemed to be at high risk and who were surveillance culture positive. Targeted MRSA active surveillance may be beneficial in guiding empiric anti-MRSA therapy.

Impact of Results of Methicillin-Resistant Staphylococcus, aureus Surveillance Culture of Nasal Specimens on Subsequent Antibiotic Prescribing Patterns

2010 ◽  
Vol 31 (8) ◽  
pp. 842-845
Author(s):  
Jörg J. Ruhe ◽  
Barry Kreiswirth ◽  
David C. Perlman ◽  
Donna Mildvan ◽  
Brian Koll
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Carrier Status ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
Negative Results ◽  
Potential Impact ◽  
Positive Results

We studied the potential impact of results of methicillin-resistant Staphylococcus aureus (MRSA) surveillance culture of nasal specimens on physicians' vancomycin-prescribing habits. We compared 116 case patients who had positive results with 116 matched control subjects who had negative results. On multivariate analyses, a positive MRSA carrier status remained strongly predictive of vancomycin use within the subsequent 12 weeks.

Impact of a Methicillin-Resistant Staphylococcus Aureus Active Surveillance Culture Protocol on Mupirocin Prescribing

2009 ◽  
Vol 44 (9) ◽  
pp. 781-784
Author(s):  
Marisel Segarra-Newnham ◽  
Kristin St. John
Keyword(s):  
Staphylococcus Aureus ◽  
Active Surveillance ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Inpatient Setting ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
The Impact ◽  
Active Surveillance Culture

Background To identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), an active surveillance culture (ASC) protocol has been in place since March 2007. Decolonization with mupirocin ointment is not recommended but may be attempted after a positive MRSA screen. Objective Assess the impact of an inpatient ASC protocol on prescribing of mupirocin nasal ointment for decolonization before and after protocol implementation. Methods A retrospective review of mupirocin inpatient prescribing and outpatient clinic requests from March 2006 through February 2007 (1 year before ASC implementation) and from March 2007 through February 2008 (1 year after ASC implementation) was conducted. Cultures for MRSA after decolonization were evaluated. Results During the 24 months reviewed, 38 inpatients received mupirocin (18 before and 20 after ASC). Only 14 patients (37%) had a follow-up nasal swab (5 before and 9 after ASC). Of these patients, 5 (36%) had a positive nasal swab after the initial decolonization attempt. Ten patients (26%) had at least 1 clinical culture positive for MRSA after the initial decolonization (7 before and 3 after ASC). Outpatient requests for mupirocin increased 2.5-fold after ASC implementation. Sixty percent of the requests were not appropriate. Conclusion After implementation of the ASC protocol, there was no change in mupirocin prescribing for decolonization in the inpatient setting. However, outpatient requests—most of which were not indicated—increased. Success of decolonization cannot be assessed because follow-up nasal screening was not universally performed.

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