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Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria.
Am J Infect Control. 2015 Jan; 43(1):31-4.AJ

Abstract

BACKGROUND

Surveillance at hospital admission for multidrug-resistant (MDR) gram-negative bacteria (GNB) is not often performed, potentially leaving patients carrying these organisms unrecognized and not placed in transmission precautions until they develop infection. Veterans Affairs (VA) facilities screen all admissions for methicillin-resistant Staphylococcus aureus (MRSA) and place positive patients in contact precautions. We assessed how often patients with MDR GNB in clinical cultures obtained within 30 days following admission would have been in contact precautions because of a positive MRSA admission screen.

METHODS

MRSA screening and MDR GNB culture results were extracted from a database of patients admitted to all VA acute care medical facilities from January 2009-December 2012.

RESULTS

Of patients with MDR GNB-positive cultures within 30 days following admission, up to 44.3% (dependent on bacterial species) would have been in contact precautions because of a clinical positive admission MRSA nasal screen. Admissions with a positive MRSA screen had odds for MDR GNB in a culture 2.5 times greater than those with a negative screen (95% confidence interval [CI], 2.4-2.6). Odds ratios were 2.4 (95% CI, 2.3-2.5) for MDR Enterobacteriaceae, 2.7 (95% CI, 2.5-2.9) for MDR Pseudomonas aeruginosa, and 4.3 (95% CI, 3.8-4.8) for MDR Acinetobacter spp.

CONCLUSIONS

Patients may be serendipitously placed in contact precautions for MDR GNB when isolated for a positive admission MRSA screen.

Authors+Show Affiliations

Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT; Department of Internal Medicine, University of Utah, Salt Lake City, UT.Veterans Affairs Reno Medical Center, Reno, NV; Department of Internal Medicine, University of Nevada, Reno, NV.Department of Veterans Affairs, Boston Veterans Affairs Health Care System, National Center for Occupational Health and Infection Control, Office of Public Health, Boston, MA; Department of Internal Medicine, Boston University, Boston, MA.Department of Internal Medicine, University of Utah, Salt Lake City, UT.Department of Veterans Affairs, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Veterans Health Administration, Washington, DC; Lexington Veterans Affairs Medical Center, Lexington, KY; Department of Internal Medicine, University of Kentucky, Lexington, KY. Electronic address: martin.evans@va.gov.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25442394

Citation

Jones, Makoto, et al. "Collateral Benefit of Screening Patients for Methicillin-resistant Staphylococcus Aureus at Hospital Admission: Isolation of Patients With Multidrug-resistant Gram-negative Bacteria." American Journal of Infection Control, vol. 43, no. 1, 2015, pp. 31-4.
Jones M, Nielson C, Gupta K, et al. Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria. Am J Infect Control. 2015;43(1):31-4.
Jones, M., Nielson, C., Gupta, K., Khader, K., & Evans, M. (2015). Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria. American Journal of Infection Control, 43(1), 31-4. https://doi.org/10.1016/j.ajic.2014.09.016
Jones M, et al. Collateral Benefit of Screening Patients for Methicillin-resistant Staphylococcus Aureus at Hospital Admission: Isolation of Patients With Multidrug-resistant Gram-negative Bacteria. Am J Infect Control. 2015;43(1):31-4. PubMed PMID: 25442394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria. AU - Jones,Makoto, AU - Nielson,Christopher, AU - Gupta,Kalpana, AU - Khader,Karim, AU - Evans,Martin, Y1 - 2014/11/07/ PY - 2014/07/16/received PY - 2014/09/10/revised PY - 2014/09/18/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/9/4/medline KW - Carbapenem-resistant Enterobacteriaceae KW - Contact precautions KW - Enterobacteriaceae KW - Infection control KW - MDRO KW - MRSA KW - Pseudomonas aeruginosa Acinetobacter KW - Screening SP - 31 EP - 4 JF - American journal of infection control JO - Am J Infect Control VL - 43 IS - 1 N2 - BACKGROUND: Surveillance at hospital admission for multidrug-resistant (MDR) gram-negative bacteria (GNB) is not often performed, potentially leaving patients carrying these organisms unrecognized and not placed in transmission precautions until they develop infection. Veterans Affairs (VA) facilities screen all admissions for methicillin-resistant Staphylococcus aureus (MRSA) and place positive patients in contact precautions. We assessed how often patients with MDR GNB in clinical cultures obtained within 30 days following admission would have been in contact precautions because of a positive MRSA admission screen. METHODS: MRSA screening and MDR GNB culture results were extracted from a database of patients admitted to all VA acute care medical facilities from January 2009-December 2012. RESULTS: Of patients with MDR GNB-positive cultures within 30 days following admission, up to 44.3% (dependent on bacterial species) would have been in contact precautions because of a clinical positive admission MRSA nasal screen. Admissions with a positive MRSA screen had odds for MDR GNB in a culture 2.5 times greater than those with a negative screen (95% confidence interval [CI], 2.4-2.6). Odds ratios were 2.4 (95% CI, 2.3-2.5) for MDR Enterobacteriaceae, 2.7 (95% CI, 2.5-2.9) for MDR Pseudomonas aeruginosa, and 4.3 (95% CI, 3.8-4.8) for MDR Acinetobacter spp. CONCLUSIONS: Patients may be serendipitously placed in contact precautions for MDR GNB when isolated for a positive admission MRSA screen. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/25442394/Collateral_benefit_of_screening_patients_for_methicillin_resistant_Staphylococcus_aureus_at_hospital_admission:_isolation_of_patients_with_multidrug_resistant_gram_negative_bacteria_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(14)01197-3 DB - PRIME DP - Unbound Medicine ER -