Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-12T11:28:53.030Z Has data issue: false hasContentIssue false
  • English
  • Français

Methicillin-resistant Staphylococcus aureus (MRSA) screening upon inpatient hospital admission: Is there concordance between nasal swab results and samples taken from skin and soft tissue?

Published online by Cambridge University Press:  12 August 2020

Natasha J. Petry ,
Anna D. Montgomery Open the ORCID record for Anna D. Montgomery [Opens in a new window] ,
Kimberly D. P. Hammer  and
Tze Shien Lo
Natasha J. Petry
Affiliation:
Department of Pharmacy Practice, North Dakota State University School of Pharmacy, Fargo, North Dakota
Anna D. Montgomery*
Affiliation:
Fargo Veterans’ Affairs Health Care System, Fargo, North Dakota Department of Public Health, North Dakota State University, Fargo, North Dakota
Kimberly D. P. Hammer
Affiliation:
Fargo Veterans’ Affairs Health Care System, Fargo, North Dakota Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
Tze Shien Lo
Affiliation:
Fargo Veterans’ Affairs Health Care System, Fargo, North Dakota Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
*
Author for correspondence: Anna D. Montgomery, E-mail: Anna.montgomery2@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with increased mortality and healthcare costs. In 2007, a Veterans’ Affairs (VA) hospital implemented a MRSA nasal screening program, following a nationwide VA mandate, in an effort to reduce healthcare-associated MRSA infections.

Objective:

To evaluate the correlation between the nasal screening results for MRSA and culture results of wound and tissue sites.

Methods:

This retrospective study was conducted on inpatients at our VA hospital. Patients were included if they had undergone nasal screening for MRSA plus culture of a wound or tissue site within 30 days of hospital admission.

Results:

In total, 337 patients underwent nasal screening and wound culture and 211 underwent nasal screening and wound and tissue cultures. The prevalence of MRSA nasal colonization was 14.2% for wound samples and 15.2% for tissue samples. The sensitivities of MRSA nasal screening for detecting MRSA were 64.6% for wound cultures and 65.5% for tissue cultures. Specificities were 86.2% and 88.8% for wound and tissue cultures, respectively. The positive predictive values (PPVs) were 43.7% and 51.2% for wound and tissue cultures, respectively, and the negative predictive values (NPVs) were high at 93.6% and 93.5%, respectively.

Conclusions:

In cases of wound or tissue samples for which culture results are pending, a negative MRSA nasal swab may be a component of the decision to withhold or discontinue MRSA-active agents.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 11 , November 2020 , pp. 1298 - 1301
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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

Keene, A, Vavagiakis, P, Lee, MH, et al. Staphylococcus aureus colonization and the risk of infection in critically ill patients. Infect Control Hosp Edidemiol 2005;26:622–628.10.1086/502591CrossRefGoogle ScholarPubMed
Peterson, LR, Boehm, S, Beaumont, JL, et al. Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: a prospective randomized clinical trial. Am J Infect Control 2016;44:1622–1627.10.1016/j.ajic.2016.04.251CrossRefGoogle ScholarPubMed
Marshall, C, Richards, M, Mcbryde, E. Do active surveillance and contact precautions reduce MRSA acquisition? A prospective interrupted time series. PLoS One 2013;8(3):e58112.10.1371/journal.pone.0058112CrossRefGoogle ScholarPubMed
Dantes, R, Mu, Y, Belflower, R. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970–1978.Google ScholarPubMed
Mermel, LA, Cartony, JM, Covington, P, Maxey, G, Morse, D. Methicillin-resistant Staphylococcus aureus colonization at different body sites: a prospective, quantitative analysis. J Clin Microbiol 2011;49:1119–1121.10.1128/JCM.02601-10CrossRefGoogle ScholarPubMed
Jarvis, WR, Jarvis, AA, Chinn, RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States healthcare facilities, 2010. Am J Infect Control 2012;40:194–200.10.1016/j.ajic.2012.02.001CrossRefGoogle Scholar
Bisaga, A, Paquette, K, Sabatini, L, Lovell, EO. A prevalence study of methicillin-resistant Staphylococcus aureus colonization in emergency department healthcare workers. Ann Emerg Med 2008;52:525.10.1016/j.annemergmed.2008.03.019CrossRefGoogle Scholar
Suffoletto, BP, Cannon, EH, Ilkhanipour, K, Yealy, DM. Prevalence of Staphylococcus aureus nasal colonization in emergency department personnel. Ann Emerg Med 2008;52:529.10.1016/j.annemergmed.2008.03.020CrossRefGoogle ScholarPubMed
Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39:776–782.10.1086/422997CrossRefGoogle ScholarPubMed
Jinadatha, C, Hussain, Z, Erickson, TA, Villamaria, FC, Copeland, LA, Huber, TW. Origin of methicillin-resistant Staphylococcus aureus healthcare-associated infections: evaluation of the role of anterior nares. Am J Inf Con 2015;43:1125–1127.10.1016/j.ajic.2015.05.026CrossRefGoogle ScholarPubMed
Jain, R, Kralovic, SM, Evans, ME, et al. Veterans’ Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.10.1056/NEJMoa1007474CrossRefGoogle Scholar
Radigan, K. Nasal screening for MRSA: the new basis for de-escalation of empiric antibiotics? Critical Care Alert 2015;23:3–4.Google Scholar
Tilahun, B, Faust, AC, McCorstin, P, Ortegon, A. Nasal colonization and lower respiratory tract infections with methicillin-resistant Staphylococcus aureus . Am J Crit Care 2015;24:8–12.10.4037/ajcc2015102CrossRefGoogle ScholarPubMed
Dangerfield, B, Chung, A, Webb, B, Seville, MT. Predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swab PCR assay for MRSA pneumonia. Antimicrob Agents Chemother 2014;58:859–864.10.1128/AAC.01805-13CrossRefGoogle ScholarPubMed
Hiett, J, Patel, RK, Tate, V, Smulian, G, Kelly, A. Using active methicillin-resistant Staphylococcus aureus surveillance nasal swabs to predict clinical respiratory culture results. Am J Health Syst Pharm 2015;72(11 suppl 1): S20–S24.10.2146/ajhp140820CrossRefGoogle ScholarPubMed
Lachenbruch, PA. McNemar Test. Wiley StatsRef: Statistics Reference Online. 2014. doi: 10.1002/9781118445112.CrossRefGoogle Scholar
Donovan, TM, Bayes’ Theorem, Mickey RM.. Bayesian Statist 2019:29–36.10.1093/oso/9780198841296.003.0003CrossRefGoogle Scholar
Xpert MRSA NxG. Cepheid website. https://www.cepheid.com/en_US/tests/Healthcare-Associated-Infections/Xpert-MRSA-NxG. Accessed June 22, 2020.Google Scholar
MRSA screening. American Association of Clinical Chemistry website. http://labtestsonline.org/tests/mrsa-screening. Updated December 6, 2006. Accessed June 17, 2020.Google Scholar
Johnson, JA, Wright, ME, Sheperd, LA, Musher, DM, Dang, BN. Nasal methicillin-resistant Staphylococcus aureus polymerase chain reaction: a potential use in guiding antibiotic therapy for pneumonia. Perm J 2015;19:34–36.10.7812/TPP/14-101CrossRefGoogle ScholarPubMed
Robicsek, A, Suseno, M, Beaumont, JL, Thomson, RB Jr, Peterson, LR. Prediction of methicillin-resistant Staphylococcus aureus involvement in disease sites by concomitant nasal sampling. J Clin Microbiol 2008;46:588–592.10.1128/JCM.01746-07CrossRefGoogle ScholarPubMed
Gunderson, CG, Holleck, JL, Chang, JJ, Merchant, N, Lin, S, Gupta, S. Diagnostic accuracy of methicillin-resistant Staphylococcus aureus nasal colonization to predict methicillin-resistant S aureus soft-tissue infections. Am J Infect Control 2016;44:1176–1177.10.1016/j.ajic.2016.03.039CrossRefGoogle ScholarPubMed