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A Clinical History of Methicillin-Resistant Staphylococcus aureus Is a Poor Predictor of Preoperative Colonization Status and Postoperative Infections

  • Judith Strymish (a1) (a2), Westyn Branch-Elliman (a3), Kamal M. F. Itani (a2) (a4) (a5), Sandra Williams (a6) and Kalpana Gupta (a1) (a5)...

In the absence of established methicillin-resistant Staphylococcus aureus (MRSA) screening programs, many centers use a history of a positive culture or a nasal screen as a surrogate for preoperative MRSA colonization status. We aimed to evaluate the test characteristics of these surrogates.


Retrospective cohort study.


Veterans Affairs Boston Healthcare System surgical patients with a preoperative nasal MRSA polymerase chain reaction (PCR) screen.


We assessed the performance of a history of a MRSA-positive culture or a positive nasal MRSA PCR screen during the year prior to surgery for predicting the preoperative nasal PCR screen result. The associations between MRSA history and postoperative outcomes, including MRSA cultures and infections, were also evaluated.


Among 4,238 patients, a positive MRSA culture history had a sensitivity of 19.7% (95% confidence interval [CI], 15.4%–24.8%) and positive predictive value of 57.3% for the preoperative nasal MRSA status. The specificity of MRSA culture history was 99% (95% CI, 98.5%–99.2%). Prior-year nasal MRSA screen results had similar test characteristics. A history of a MRSA-positive culture was associated with an increased risk of postoperative MRSA-positive cultures (risk ratio [RR], 3.54 [95% CI, 1.70–7.37], P< .001) but not of infections (RR, 1.71 [95% CI, 0.58–5.01]), after adjustment for preoperative nasal MRSA status, vancomycin surgical prophylaxis, surgical scrub, and age.


A history of a MRSA-positive culture and a positive nasal PCR screen are poor surrogate markers of preoperative colonization status, missing at least 70% of MRSA-colonized patients. Prior-year history is also not independently associated with MRSA-related postoperative infections. Strong consideration should be given to preoperative MRSA screening in patients at high risk for surgical complications.

Corresponding author
VA Boston HCS, 1400, VFW Parkway, 111 Med, West Roxbury, MA 02132 (
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1.Diekema D, Johannsson B, Herwaldt L, et al.Current practice in Staphylococcus aureus screening and decolonization. Infect Control Hosp Epidemiol 2011;32(10):10421044.
2.Kluytmans JAJW, Mouton JW, Ijzerman EP, et al.Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995;171(1):216219.
3.Bode LGM, Kluytmans JAJW, Wertheim HFL, et al.Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362(1):917.
4.Gupta K, Strymish J, Abi-Haidar Y, Williams SA, Itani KM. Preoperative nasal methicillin-resistant Staphylococcus aureus status, surgical prophylaxis, and risk-adjusted postoperative outcomes in veterans. Infect Control Hosp Epidemiol 2011;32(8):791796.
5.Anderson DJ, Kaye KS, Classen D, et al.Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S51S61.
6.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(6):11231128.
7.Schweizer ML, Furuno JP, Harris AD, et al.Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremia. BMC Infect Dis 2011;11:279, doi:10.1186/1471-2334-11-279.
8.Wolk DM, Picton E, Johnson D, et al.Multicenter evaluation of the Cepheid Xpert methicillin-resistant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares. J Clin Microbiol 2009;47(3):758764. San N, Denis O, Gasasira MF, De Mendonca R, Nonhoff C, Struelens MJ. Controlled evaluation of the IDI-MRSA assay for detection of colonization by methicillin-resistant Staphylococcus aureus in diverse mucocutaneous specimens. J Clin Microbiol 2007;45(4):10981101.
10.Olchanski N, Mathews C, Fusfeld L, Jarvis W. Assessment of the influence of test characteristics on the clinical and cost impacts of methicillin-resistant Staphylococcus aureus screening programs in US hospitals. Infect Control Hosp Epidemiol 2011;32(3):250257.
11.Baker SE, Brecher SM, Robillard E, Strymish J, Lawler E, Gupta K. Extranasal methicillin-resistant Staphylococcus aureus colonization at admission to an acute care Veterans Affairs hospital. Infect Control Hosp Epidemiol 2010;31(1):4246.
12.Scanvic A, Denic L, Gaillon S, Giry P, Andremont A, Lucet JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32(10):13931398.
13.Harbarth S, Fankhauser C, Schrenzel J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299(10):11491157.
14.Schweizer ML, Furuno JP, Harris AD, et al.Clinical utility of infection control documentation of prior methicillin-resistant Staphylococcus aureus colonization or infection for optimization of empirical antibiotic therapy. Infect Control Hosp Epidemiol 2008;29(10):972974.
15.Salgado CD, Farr BM. What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures? Infect Control Hosp Epidemiol 2006;27(2):116121.
16.Jain R, Kralovic SM, Evans ME, et al.Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364(15):14191430.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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