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What Proportion of Hospital Patients Colonized With Methicillin-Resistant Staphylococcus aureus Are Identified by Clinical Microbiological Cultures?

Published online by Cambridge University Press:  21 June 2016

Cassandra D. Salgado  and
Barry M. Farr
Cassandra D. Salgado*
Affiliation:
Medical University of South Carolina, Charleston, Charlottesville
Barry M. Farr
Affiliation:
University of Virginia Health System, Charlottesville
*
Division of Infectious Diseases, Medical University of South Carolina, 100 Doughty Street, Suite 210 IOP South, Charleston, SC 29425 (salgado@musc.edu)
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Abstract

Background.

Most hospitals in the United States do not perform active surveillance cultures and, thus, rely on clinical microbiological cultures (CMCs) to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA). We sought to determine what proportion of patients who are colonized with MRSA at admission are identified by CMCs during hospitalization.

Methods.

From February 1998 through November 2002, patients found to be colonized with MRSA at admission by use of active surveillance cultures were identified. The proportion of colonized patients who had a CMC that was positive for MRSA, the number of CMCs performed and their type (ie, according to the anatomical site from which specimens were obtained for culture), and the number and type of CMCs that were positive for MRSA were calculated.

Results.

Four hundred thirty-seven patients were found to be colonized with MRSA at admission, and 98 of 1,238 CMCs (7.9%; 95% confidence interval, 6.5%-9.6%) performed for 66 of these patients (15%; 95% confidence interval, 11.9%-18.8%) were positive for MRSA. The number of nonisolated days that would have occurred by relying on CMCs to identify MRSA-colonized patients was 3,247 (mean, 7.4 days per patient). Among the anatomical sites from which specimens were obtained for CMC, wounds demonstrated the highest sensitivity (30.2%) for identifying MRSA-colonized patients.

Conclusions.

CMCs failed to identify 85% of MRSA-colonized patients, because, in part, CMCs identified only a small proportion of colonized patients. Because many studies have shown a decrease in the transmission of MRSA from colonized patients for whom contact precautions, rather than standard precautions, are used, the findings of this study suggest that failure to identify colonized patients and to use contact precautions may be an important reason for the increasing rate of nosocomial MRSA infection in hospitals in the United States.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 2 , February 2006 , pp. 116 - 121
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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