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Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-Resistant Staphylococcus aureus Colonization at the Time of Hospital or Intensive Care Unit Admission

Published online by Cambridge University Press:  02 January 2015

James A. McKinnell
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California Torrance Memorial Medical Center, Torrance, California
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine, California
Samantha J. Eells
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
Eric Cui
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine, California
Loren G. Miller
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
Corresponding
E-mail address:

Abstract

Objective.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and intensive care unit (ICU) admission in many states. However, MRSA colonization at extranasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extranasal testing for MRSA.

Design.

We searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extranasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs and those admitted to hospitals with a high prevalence (6% or greater) or low prevalence (less than 6%) of MRSA carriers. Data were extracted using a standardized instrument.

Results.

We reviewed 4,381 abstracts and 735 articles. Twenty-three articles met the criteria for analysis (n = 39,479 patients). Extranasal MRSA screening increased the yield by approximately one-third over nares alone. The yield was similar at ICU admission (weighted average, 33%; range, 9%–69%) and hospital admission in high-prevalence (weighted average, 37%; range, 9%–86%) and low-prevalence (weighted average, 50%; range, 0%–150%) populations. For comparisons between individual extranasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum, by 20%; wounds, by 17%; and axilla, by 7%.

Conclusions.

Extranasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared with nares screening alone. Findings were consistent among subpopulations examined. Extranasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Hidron, AI, Edwards, JR, Patel, J, et al; for the National Healthcare Safety Network Team and Participating National Healthcare Safety Network Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29(11):9961011.CrossRefGoogle ScholarPubMed
2.Sader, HS, Streit, JM, Fritsche, TR, Jones, RN. Antimicrobial susceptibility of gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002-2004). Clin Microbiol Infect 2006;12(9):844852.CrossRefGoogle Scholar
3.Voss, A, Milatovic, D, Wallrauch-Schwarz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13(1):5055.CrossRefGoogle Scholar
4.Fluit, AC, Wielders, CL, Verhoef, J, Schmitz, FJ. Epidemiology and susceptibility of 3,051 Staphylococcus aureus isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001;39(10):37273732.CrossRefGoogle ScholarPubMed
5.Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364(15):14191430.CrossRefGoogle ScholarPubMed
6.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409418.CrossRefGoogle ScholarPubMed
7.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24(5):362386.Google ScholarPubMed
8.Coia, JE, Duckworth, GJ, Edwards, DI, et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(suppl 1):S1S44.CrossRefGoogle Scholar
9.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10suppl 2):S165S193.CrossRefGoogle ScholarPubMed
10.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43(8):971978.CrossRefGoogle ScholarPubMed
11.West, TE, Guerry, C, Hiott, M, Morrow, N, Ward, K, Salgado, CD. Effect of targeted surveillance for control of methicillin-resistant Staphylococcus aureus in a community hospital system. Infect Control Hosp Epidemiol 2006;27(3):233238.CrossRefGoogle Scholar
12.Safdar, N, Marx, J, Meyer, NA, Maki, DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34(8):476483.CrossRefGoogle Scholar
13.Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31(8):10511057.CrossRefGoogle ScholarPubMed
14.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37(6):18581865.CrossRefGoogle ScholarPubMed
15. MRSA laws. Association for Professionals in Infection Control and Hospital Epidemiology website, http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/MRSA_map.gif. Published 2011. Accessed March 2, 2012.Google Scholar
16.Eveillard, M, de Lassence, A, Lancien, E, Barnaud, G, Ricard, JD, Joly-Guillou, ML. Evaluation of a strategy of screening multiple anatomical sites for methicillin-resistant Staphylococcus aureus at admission to a teaching hospital. Infect Control Hosp Epidemiol 2006;27(2):181184.CrossRefGoogle ScholarPubMed
17.Batra, R, Eziefula, AC, Wyncoll, D, Edgeworth, J. Throat and rectal swabs may have an important role in MRSA screening of critically ill patients. Intensive Care Med 2008;34(9):17031706.CrossRefGoogle ScholarPubMed
18.Harbarth, S, Schrenzel, J, Renzi, G, Akakpo, C, Ricou, B. Is throat screening necessary to detect methicillin-resistant Staphylococcus aureus colonization in patients upon admission to an intensive care unit? J Clin Microbiol 2007;45(3):10721073.CrossRefGoogle Scholar
19.Baker, SE, Brecher, SM, Robillard, E, Strymish, J, Lawler, E, Gupta, K. Extranasal methicillin-resistant Staphylococcus aureus colonization at admission to an acute care Veterans Affairs hospital. Infect Control Hosp Epidemiol 2010;31(1):4246.CrossRefGoogle Scholar
20.Chow, A, Win, M-K, Wong, C-S, Leo, Y-S. Universal methicillin-resistant Staphylococcus aureus (MRSA) screening: comparison of anatomic screening sites for patients with high and low prevalence of MRSA carriage. Infect Control Hosp Epidemiol 2012; 33(3):315317.CrossRefGoogle ScholarPubMed
21.Bickel, PJ, Hammel, EA, O'Connell, JW. Sex bias in graduate admissions: data from Berkeley. Science 1975;187(4175):398404.CrossRefGoogle ScholarPubMed
22.Pearl, J. Causality: Models, Reasoning, and Inference. Cambridge: Cambridge University Press, 2000.Google Scholar
23.Papia, G, Louie, M, Traila, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999;20(7):473477.CrossRefGoogle ScholarPubMed
24.Troillet, N, Carmeli, Y, Samore, MH, et al. Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19(3):181185.CrossRefGoogle ScholarPubMed
25.Thyagarajan, D, Sunderamoorthy, D, Haridas, S, Beck, S, Praveen, P, Johansen, A. MRSA colonisation in patients admitted with hip fracture: implications for prevention of surgical site infection. Acta Orthop Belg 2009;75(2):252257.Google ScholarPubMed
26.Huang, YC, Chao, AS, Chang, SD, et al. Association of Staphylococcus aureus colonization in parturient mothers and their babies. Pediatr Infect Dis J 2009;28(8):742744.CrossRefGoogle ScholarPubMed
27.Esposito, S, Capuano, A, Noviello, S, et al. Modification of patients' endogenous bacterial flora during hospitalization in a large teaching hospital in Naples. J Chemother 2003;15(6):568573.CrossRefGoogle Scholar
28.Currie, A, Davis, L, Odrobina, E, et al. Sensitivities of nasal and rectal swabs for detection of methicillin-resistant Staphylococcus aureus colonization in an active surveillance program. J Clin Microbiol 2008;46(9):31013103.CrossRefGoogle Scholar
29.Beigi, R, Hanrahan, J. Staphylococcus aureus and MRSA colonization rates among gravidas admitted to labor and delivery: a pilot study. Infect Dis Obstet Gynecol 2007;2007:70876.CrossRefGoogle ScholarPubMed
30.Samad, A, Banerjee, D, Carbarns, N, Ghosh, S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect 2002; 51(1):4346.CrossRefGoogle ScholarPubMed
31.Furuno, JP, McGregor, JC, Harris, AD, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166(5):580585.CrossRefGoogle ScholarPubMed
32.Nishikawa, M, Tanaka, T, Nakashima, K, et al. Screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission to a geriatric hospital. Arch Gerontol Geriatr 2009;49(2): 242245.CrossRefGoogle ScholarPubMed
33.Dupeyron, C, Campillo, B, Richardet, JP, Soussy, CJ. Long-term efficacy of mupirocin in the prevention of infections with meticillin-resistant Staphylococcus aureus in a gastroenterology unit. J Hosp Infect 2006;63(4):385392.CrossRefGoogle Scholar
34.Girou, E, Azar, J, Wolkenstein, P, Cizeau, F, Brun-Buisson, C, Roujeau, JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 2000; 21(9):583587.CrossRefGoogle Scholar
35.Campillo, B, Dupeyron, C, Richardet, JP. Epidemiology of hospital-acquired infections in cirrhotic patients: effect of carriage of methicillin-resistant Staphylococcus aureus and influence of previous antibiotic therapy and norfloxacin prophylaxis. Epidemiol Infect 2001;127(3):443450.CrossRefGoogle ScholarPubMed
36.Dupeyron, C, Campillo, SB, Mangeney, N, Richardet, JP, Leluan, G. Carriage of Staphylococcus aureus and of gram-negative bacilli resistant to third-generation cephalosporins in cirrhotic patients: a prospective assessment of hospital-acquired infections. Infect Control Hosp Epidemiol 2001;22(7):427432.CrossRefGoogle ScholarPubMed
37.van Hal, SJ, Stark, D, Lockwood, B, Marriott, D, Harkness, J. Methicillin-resistant Staphylococcus aureus (MRSA) detection: comparison of two molecular methods (IDI-MRSA PCR assay and Geno Type MRSA Direct PCR assay) with three selective MRSA agars (MRSA ID, MRSASelect, and CHROMagar MRSA) for use with infection-control swabs. J Clin Microbiol 2007;45(8):24862490.CrossRefGoogle Scholar
38.Rohr, U, Wilhelm, M, Muhr, G, Gatermann, S. Qualitative and (semi)quantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients. Int J Hyg Environ Health 2004;207(1):5155.CrossRefGoogle ScholarPubMed
39.Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163(2): 181188.CrossRefGoogle ScholarPubMed
40.Ho, PL. Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission. Crir Care Med 2003;31(4):11751182.CrossRefGoogle ScholarPubMed
41.Matheson, A, Christie, P, Stari, T, et al. Nasal swab screening for methicillin-resistant Staphylococcus aureus—how well does it perform? a cross-sectional study. Infect Control Hosp Epidemiol 2012;33(8):803808.CrossRefGoogle ScholarPubMed
42.Albrich, WC, Harbarth, S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8(5):289301.CrossRefGoogle ScholarPubMed
43.Hardy, KJ, Oppenheim, BA, Gossain, S, Gao, F, Hawkey, PM. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006; 27(2):127132.CrossRefGoogle ScholarPubMed
44.Saigado, CD, Farr, BM. What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures? Infect Control Hosp Epidemiol 2006;27(2):116121.CrossRefGoogle Scholar
45.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330338.CrossRefGoogle ScholarPubMed
46.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18(9):622627.CrossRefGoogle ScholarPubMed
47.Chang, S, Sethi, AK, Stiefel, U, Cadnum, JL, Donskey, CJ. Occurrence of skin and environmental contamination with methicillin-resistant Staphylococcus aureus before results of polymerase chain reaction at hospital admission become available. Infect Control Hosp Epidemiol 2010;31(6):607612.CrossRefGoogle ScholarPubMed
48.Morgan, DJ, Rogawski, E, Thorn, KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40(4):10451051.CrossRefGoogle ScholarPubMed
49.Treakle, AM, Thorn, KA, Furuno, JP, Strauss, SM, Harris, AD, Perencevich, EN. Bacterial contamination of health care workers' white coats. Am J Infect Control 2009;37(2):101105.CrossRefGoogle ScholarPubMed
50.Snyder, GM, Thorn, KA, Furuno, JP, et al. Detection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol 2008;29(7):583589.CrossRefGoogle ScholarPubMed
51.Jarvis, WR, Jarvis, AA, Chinn, RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012;40(3): 194200.CrossRefGoogle ScholarPubMed
52.Chang, S, Sethi, AK, Eckstein, BC, Stiefel, U, Cadnum, JL, Donskey, CJ. Skin and environmental contamination with methicillin-resistant Staphylococcus aureus among carriers identified clinically versus through active surveillance. Clin Infect Dis 2009; 48(10):14231428.CrossRefGoogle ScholarPubMed
53.Yang, ES, Tan, J, Eells, S, Rieg, G, Tagudar, G, Miller, LG. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect 2010;16(5):425431.CrossRefGoogle ScholarPubMed

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Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-Resistant Staphylococcus aureus Colonization at the Time of Hospital or Intensive Care Unit Admission
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