Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-16T13:21:53.024Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of Systematic Versus Selective Screening for Methicillin-Resistant Staphylococcus aureus Carriage in a High-Risk Dermatology Ward

Published online by Cambridge University Press:  02 January 2015

Emmanuelle Girou ,
Joyce Azar ,
Pierre Wolkenstein ,
Florence Cizeau ,
Christian Brun-Buisson  and
Jean-Claude Roujeau
Emmanuelle Girou
Affiliation:
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Joyce Azar
Affiliation:
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Pierre Wolkenstein
Affiliation:
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Florence Cizeau
Affiliation:
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Christian Brun-Buisson*
Affiliation:
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Jean-Claude Roujeau
Affiliation:
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
*
Unité d'Hygiène et Prévention de l'Infection, CHU Henri Mondor, 94010 Créteil, France
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare two strategies for screening methicillin-resistant Staphylococcus aureus (MRSA) carriers in a high-risk dermatology ward: systematic screening of all admitted patients versus selective screening of patients at risk.

Design:

The two strategies were applied prospectively during two consecutive periods. In period A (8.5 months), only patients transferred from other wards, or with a history of prior hospitalization, or presenting chronic wounds or disease with denuded skin were considered at high risk of MRSA carriage and sampled. In period B (7.5 months), all admitted patients were systematically screened. End-points were the number of patients having a MRSA-positive screening sample on admission during period B and having none of the risk factors used in period A, the rate of imported MRSA cases, and the rate of acquired cases.

Setting:

A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses.

Patients:

The study included 729 dermatology inpatients (370 in period A and 359 in period B).

Results:

During period A, screening samples were obtained on admission for 30% of patients (77% of the patients at risk) and identified 25 MRSA carriers. During period B, 90.5% of admitted patients were screened, and 26 MRSA carriers were detected on admission; all of these patients belonged to at least one predefined category at risk for carriage. Overall rates of imported and acquired cases were similar between the two periods (6.8% vs 7.5%, and 2.9% vs 2.4%, respectively).

Conclusions:

A screening strategy targeted to patients at risk of harboring MRSA has similar sensitivity and is more cost-effective than a strategy of systematic screening to identify MRSA carriers on admission.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 9 , September 2000 , pp. 583 - 587
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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. Ayliffe, GA. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1997;24(suppl 1):S74–S79.Google Scholar
2. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
3. Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221S–227S.Google Scholar
4. The Hôpital Propre II Study Group. Methicillin-resistant Staphylococcus aureus in French hospitals: a 2-month survey in 43 hospitals. Infect Control Hosp Epidemiol 1999;20:478–486.Google Scholar
5. Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with bacteremia due to methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1995;21:1417–1423.Google Scholar
6. Spencer, RC. Predominant pathogens found in the European Prevalence of Infection in Intensive Care study. Eur J Clin Microbiol Infect Dis 1996;15:281–285.Google Scholar
7. Vincent, JL, Bihari, D, Suter, PM, Bruining, HA, White, J, Nicolas-Chanoin, MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. JAMA 1995;274:639–644.Google Scholar
8. Aubry-Damon, H, Legrand, P, Brun-Buisson, C, Astier, A, Soussy, CJ, Leclercq, R. Reemergence of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus: roles of an infection control program and changes in aminoglycoside use. Clin Infect Dis 1997;25:647–653.CrossRefGoogle ScholarPubMed
9. Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543–550.Google Scholar
10. Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: clinical studies. J Infect Dis 1979;139:273–279.Google Scholar
11. Ransjo, U, Malm, M, Hambraeus, A, Artursson, G, Hedlund, A. Methicillin-resistant Staphylococcus aureus in two burn units: clinical significance and epidemiological control. J Hosp Infect 1989;13:355–365.Google Scholar
12. Sheridan, RL, Weber, J, Benjamin, J, Pasternack, MS, Tompkins, RG. Control of methicillin-resistant Staphylococcus aureus in a pediatric burn unit. Am J Infect Control 1994;22:340–345.CrossRefGoogle Scholar
13. Bang, RL, Gang, RK, Sanyal, SC, Mokaddas, E, Ebrahim, MK. Burn septicaemia: an analysis of 79 patients. Burns 1998;24:354–361.Google Scholar
14. Papia, G, Louie, M, Tralla, 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;20:473–477.Google Scholar
15. Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus. A cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.Google Scholar
16. Antibiogram Committee of the French Society for Microbiology. Official Statement 1999 [in French]. Pathol Biol (Paris) 1997;47:845–872.Google Scholar
17. Hospital Infection Society and British Society for Antimicrobial Chemotherapy. Revised guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus . J Hosp Infect 1990;16:351–377.Google Scholar
18. Hospital Infection Society and British Society for Antimicrobial Chemotherapy. Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. J Hosp Infect 1998;39:253–290.Google Scholar
19. Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1994;19:1123–1128.Google Scholar
20. Fierobe, L, Decré, D, Muller, C, Lucet, JC, Marmuse, JP, Mantz, J, et al. Methicillin-resistant Staphylococcus aureus as a causative agent of post-operative intra-abdominal infection: relation to nasal colonization. Clin Infect Dis 1999;29:1231–1238.Google Scholar
21. Boyce, JM, Jackson, MM, Pugliese, G, Batt, MD, Fleming, D, Garner, JS, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. The AHA Technical Panel on Infections Within Hospitals. Infect Control Hosp Epidemiol 1994;15:105–115.Google Scholar
22. Coello, R, Jimenez, J, Garcia, M, Arroyo, P, Minguez, D, Fernandez, C, et al. Prospective study of infection, colonization, and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994;13:74–81.Google Scholar
23. Cafferkey, MT, Hone, R, Keane, CT. Sources and outcome for methicillin-resistant Staphylococcus aureus bacteremia. J Hosp Infect 1988;11:136–143.Google Scholar
24. Cookson, B. Is it time to stop searching for MRSA? Screening is still important. BMJ 1997;314:664–665.CrossRefGoogle ScholarPubMed
25. Teare, EL, Barrett, SP. Is it time to stop searching for MRSA? Stop the ritual of tracing colonised people. BMJ 1997;314:665–666.Google Scholar