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Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Real-Time PCR: A Predictive Tool for Contamination of the Hospital Environment

Published online by Cambridge University Press:  05 January 2015

Daniel J. Livorsi ,
Sana Arif ,
Patricia Garry ,
Madan G. Kundu ,
Sarah W. Satola ,
Thomas H. Davis ,
Byron Batteiger  and
Amy B. Kressel
Daniel J. Livorsi*
Affiliation:
Richard Roudebush VA Medical Center, Indianapolis, IN Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
Sana Arif
Affiliation:
Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
Patricia Garry
Affiliation:
Richard Roudebush VA Medical Center, Indianapolis, IN
Madan G. Kundu
Affiliation:
Indiana University Fairbanks School of Public Health, Department of Biostatistics, Indianapolis, IN
Sarah W. Satola
Affiliation:
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA Atlanta VA Medical Center, Decatur, GA
Thomas H. Davis
Affiliation:
Division of Microbiology, Indiana University School of Medicine, Indianapolis, IN
Byron Batteiger
Affiliation:
Richard Roudebush VA Medical Center, Indianapolis, IN Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
Amy B. Kressel
Affiliation:
Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
*
Address correspondence to Daniel Livorsi, MD, MSc, Assistant Professor, Division of Infectious Diseases, Indiana University School of Medicine, 545 Barnhill Drive, EH 421 Indianapolis, IN 46202 (dlivorsi@iu.edu).
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Abstract

OBJECTIVE

We sought to determine whether the bacterial burden in the nares, as determined by the cycle threshold (CT) value from real-time MRSA PCR, is predictive of environmental contamination with MRSA.

METHODS

Patients identified as MRSA nasal carriers per hospital protocol were enrolled within 72 hours of room admission. Patients were excluded if (1) nasal mupirocin or chlorhexidine body wash was used within the past month or (2) an active MRSA infection was suspected. Four environmental sites, 6 body sites and a wound, if present, were cultured with premoistened swabs. All nasal swabs were submitted for both a quantitative culture and real-time PCR (Roche Lightcycler, Indianapolis, IN).

RESULTS

At study enrollment, 82 patients had a positive MRSA-PCR. A negative correlation of moderate strength was observed between the CT value and the number of MRSA colonies in the nares (r=−0.61; P<0.01). Current antibiotic use was associated with lower levels of MRSA nasal colonization (CT value, 30.2 vs 27.7; P<0.01). Patients with concomitant environmental contamination had a higher median log MRSA nares count (3.9 vs 2.5, P=0.01) and lower CT values (28.0 vs 30.2; P<0.01). However, a ROC curve was unable to identify a threshold MRSA nares count that reliably excluded environmental contamination.

CONCLUSIONS

Patients with a higher burden of MRSA in their nares, based on the CT value, were more likely to contaminate their environment with MRSA. However, contamination of the environment cannot be predicted solely by the degree of MRSA nasal colonization.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 34 - 39
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Author’s name has been corrected since original publication. An erratum notice detailing this change was also published (DOI 10.1017/ice.2015.10).

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