Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-17T10:54:23.763Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictive Value and Cost-Effectiveness Analysis of a Rapid Polymerase Chain Reaction for Preoperative Detection of Nasal Carriage of Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Nabin K. Shrestha ,
Kenneth M. Shermock ,
Steven M. Gordon ,
Marion J. Tuohy ,
Deborah A. Wilson ,
Roberta E. Cwynar ,
Michael K. Banbury ,
David L. Longworth ,
Carlos M. Isada  and
Steven D. Mawhorter
...Show all authors
Nabin K. Shrestha
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Kenneth M. Shermock
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Steven M. Gordon
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Marion J. Tuohy
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Deborah A. Wilson
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Roberta E. Cwynar
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Michael K. Banbury
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
David L. Longworth
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Carlos M. Isada
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Steven D. Mawhorter
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
Gary W. Procop*
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
*
The Cleveland Clinic Foundation, 9500 Euclid Avenue/S-32, Cleveland, OH 44195
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the accuracy and cost-effectiveness of a polymerase chain reaction (PCR) for detecting nasal carriage of Staphylococcus aureus directly from clinical specimens.

Cross-Sectional Study:

This occurred in a tertiary-care hospital in Cleveland, Ohio, and included 239 consecutive patients who were scheduled for a cardiothoracic surgical procedure. Conventional cultures and a PCR for S. aureus from nasal swabs were used as measurements.

Cost-Effectiveness Analysis:

Data sources were market prices and Bureau of Labor Statistics. The time horizon was the maximum period for availability of culture results (3 days). Interventions included universal mupirocin therapy without testing; initial therapy, with termination if PCR negative (treat-PCR); initial therapy, with termination if culture negative (treat-culture); treat PCR-positive carriers (PCR-guided treatment); and treat culture-positive carriers (culture-guided treatment). The perspective was institutional and costs and the length of time to treatment were outcome measures.

Results:

Sixty-seven (28%) of the 239 swabs grew S. aureus. Rapid PCR was 97.0% sensitive and 97.1% specific for the detection of S. aureus. For populations with prevalences of nasal S. aureus carriage of up to 50%, the PCR assay had negative predictive values of greater than 97%. PCR-guided treatment had the lowest incremental cost-effectiveness ratio ($1.93 per additional day compared with the culture strategy). Among immediate treatment strategies, treat-PCR was most cost-effective. The universal therapy strategy cost $38.19 more per additional day gained with carrier identification compared with the PCR strategy.

Conclusion:

Rapid real-time PCR is an accurate, rapid, and cost-effective method for identifying S. aureus carriers for preoperative intervention.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 327 - 333
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report: data summary from October 1986-April 1996, issued May 1996. Am J Infect Control 1996;24:380–388.CrossRefGoogle Scholar
2.von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia: study group. N Engl J Med 2001;344:11–16.CrossRefGoogle ScholarPubMed
3.Reagan, DR, Doebbeling, BN, Pfaller, MA, et al.Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.CrossRefGoogle ScholarPubMed
4.Wenzel, RP, Perl, TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hosp Infect 1995;31:13–24.CrossRefGoogle ScholarPubMed
5.Boelaert, JR, Van Landuyt, HW, Gordts, BZ, De Baere, YA, Messer, SA, Herwaldt, LANasal and cutaneous carriage of Staphylococcus aureus in hemodialysis patients: the effect of nasal mupirocin. Infect Control Hosp Epidemiol 1996;17:809–811.CrossRefGoogle Scholar
6.Fernandez, C, Gaspar, C, Torrellas, A, et al.A double-blind, randomized, placebo-controlled clinical trial to evaluate the safety and efficacy of mupirocin calcium ointment for eliminating nasal carriage of Staphylococcus aureus among hospital personnel. J Antimicrob Chemother 1995;35:399–408.CrossRefGoogle ScholarPubMed
7.Kluytmans, JAMouton, JW, VandenBergh, MF, et al.Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996;17:780–785.CrossRefGoogle ScholarPubMed
8.Perl, TM, Cullen, JJ, Wenzel, RRet al.Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:1871–1877.CrossRefGoogle ScholarPubMed
9.Cimochowski, GE, Harostock, MD, Brown, R, Bernardi, M, Alonzo, N, Coyle, K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg 2001;71:1572–1579.CrossRefGoogle Scholar
10.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefGoogle ScholarPubMed
11.Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH. Staphylococcus and Micrococcus. In: Doern, GV, Ferraro, MJ, Gilligan, PH, Janda, JM, vonGraevenitz, A, eds. Manual of Clinical Microbiology. Washington, DC: ASM Press; 1999:264–282.Google Scholar
12.Wittwer, CT, Herrmann, MG, Moss, AA, Rasmussen, RP. Continuous fluorescence monitoring of rapid cycle DNA amplification. Biotechniques 1997;22:130-131, 134–138.CrossRefGoogle ScholarPubMed
13.Martineau, F, Picard, FJ, Roy, PH, Ouellette, M, Bergeron, MG. Species-specific and ubiquitous-DNA-based assays for rapid identification of Staphylococcus aureus. J Clin Microbiol 1998;36:618–623.CrossRefGoogle ScholarPubMed
14.Shrestha, NK, Tuohy, MJ, Hall, GS, Isada, CM, Procop, GW. Rapid identification of Staphylococcus aureus and the mecA gene from BacT/ALERT blood culture bottles using the LightCycler system. J Clin Microbiol 2002;40:2659–2661.CrossRefGoogle ScholarPubMed
15.Reischl, U, Linde, HJ, Metz, M, Leppmeier, B, Lehn, N. Rapid identification of methicillin-resistant Staphylococcus aureus and simultaneous species confirmation using real-time fluorescence PCR. J Clin Microbiol 2000;38:2429–2433.CrossRefGoogle ScholarPubMed
16.Oliveira, K, Procop, GW, Wilson, D, Coull, J, Stender, H. Rapid identification of Staphylococcus aureus directly from blood cultures by fluorescence in situ hybridization with peptide nucleic acid probes. J Clin Microbiol 2002;40:247–251.CrossRefGoogle ScholarPubMed
17.Pagano, M, Gauvreau, K. Principles of Biostatistics. Pacific Grove, CA: Duxbury; 2000:91–99.Google Scholar
18.200i Drug Topics Red Book. Montvale, NJ: Medical Economics; 2001:208.Google Scholar
19.Roche Diagnostic Corporation. Indianapolis, IN: Roche Diagnostic; 2002.Google Scholar
20.Allegiance Healthcare Corporation. McGaw Park, IL: Allegiance Healthcare; 2002.Google Scholar
21.Bureau of Labor Statistics. National Compensation Survey. Washington, DC: Bureau of Labor Statistics; 2002. Available at www.bls.gov/ncs/home.htm. Accessed January 26, 2002.Google Scholar
22.Drummond, MF, O'Brien, B, Stoddart, GL, Torrance, GW. Methods for the Economic Evaluation of Health Care Programmes, 2nd ed. Oxford: Oxford Medical Publications; 1997.Google Scholar
23.Johannesson, M, Weinstein, MC. On the decision rules of cost-effectiveness analysis. Journal of Health Economics 1993;12:459–467.CrossRefGoogle ScholarPubMed
24.Karlsson, G, Johannesson, M. The decision rules of cost-effectiveness analysis. Pharmacoeconomics 1996;9:113–120.CrossRefGoogle ScholarPubMed
25.Schmitz, FJ, Lindenlauf, E, Hofmann, B, et al.The prevalence of low- and high-level mupirocin resistance in staphylococci from 19 European hospitals. J Antimicrob Chemother 1998;42:489–495.CrossRefGoogle Scholar
26.Watanabe, H, Masaki, H, Asoh, N, et al.Emergence and spread of low-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from a community hospital in Japan. J Hosp Infect 2001;47:294–300.CrossRefGoogle ScholarPubMed
27.Norazah, A, Koh, YT, Ghani Kamel, A, Alias, R, Lim, VK. Mupirocin resistance among Malaysian isolates of methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2001;17:411–414.CrossRefGoogle ScholarPubMed
28.Kauffman, CATerpenning, MS, He, X, et al.Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment. Am J Med 1993;94:371–378.CrossRefGoogle ScholarPubMed
29.Annigeri, R, Conly, J, Vas, S, et al.Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin prophylaxis to prevent exit-site infection. Perit Dial Int 2001;21:554–559.CrossRefGoogle ScholarPubMed
30.Hodgson, JE, Curnock, SP, Dyke, KG, Morris, R, Sylvester, DR, Gross, MS. Molecular characterization of the gene encoding high-level mupirocin resistance in Staphylococcus aureus J2870. Antimicrob Agents Chemother 1994;38:1205–1208.CrossRefGoogle ScholarPubMed
31.Nunes, EL, dos Santos, KR, Mondino, PJ, Bastos Mdo, C, Giambiagi-deMarval, M. Detection of ileS-2 gene encoding mupirocin resistance in methicillin-resistant Staphylococcus aureus by multiplex PCR. Diagn Microbiol Infect Dis 1999;34:77–81.CrossRefGoogle ScholarPubMed