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Rapid, Highly Discriminatory Binary Genotyping to Demonstrate Methicillin-Resistant Staphylococcus aureus Transmission in a Tertiary Care Intensive Care Unit

Published online by Cambridge University Press:  18 December 2014

CW Sadler
Affiliation:
Junior Medical Officer, Royal Adelaide Hospital, Adelaide, Australia
V Nayyar
Affiliation:
Intensive Care Unit, Westmead Hospital, Sydney, Australia
ER Stachowski
Affiliation:
Intensive Care Unit, Westmead Hospital, Sydney, Australia
MVN O’Sullivan
Affiliation:
Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, Australia University of Sydney, Australia
GL Gilbert
Affiliation:
Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, Australia University of Sydney, Australia
K Byth
Affiliation:
University of Sydney, Australia
Corresponding

Abstract

Objectives

No previous studies of methicillin-resistant Staphylococcus aureus (MRSA) epidemiology in adult intensive care units (ICUs) have assessed the utility of rapid, highly discriminatory strain typing in the investigation of transmission events.

Design

Observational.

Setting

A 22-bed medical-surgical adult ICU.

Patients

Those admissions MRSA-positive on initial screening and all admissions <48 hours in duration were excluded, leaving a cohort of 653 patients (median age, 61 years; APACHE-II, 19).

Methods

We conducted this study of MRSA transmission over 1 year (August 1, 2011 to July 31, 2012) using a multiplex PCR-based reverse line blot (mPCR/RLB) assay to genotype isolates from surveillance swabs obtained at admission and twice weekly during ICU stays. MRSA prevalence and incidence rates were calculated and transmission events were identified using strain matching. Colonization pressure was calculated daily by summation of all MRSA cases.

Results

Of 1,030 admissions to ICU during the study period, 349 patients were excluded. MRSA acquisition occurred during 31 of 681 (4.6%) remaining admissions; 19 of 31(61%) acquisitions were genotype-confirmed, including 7 (37%) due to the most commonly transmitted strain. Moving averages of MRSA patient numbers on the days prior to a documented event were used in a Poisson regression model. A significant association was found between transmission and colonization pressure when the average absolute colonization pressure on the previous day was ≥3 (χ2=7.41, P=0.01).

Conclusions

mPCR/RLB characterizes MRSA isolates within a clinically useful time frame for identification of single-source clusters within the ICU. High MRSA colonization pressure (≥3 MRSA-positive patients) on a given day is associated with an increased likelihood of a transmission event.

Infect Control Hosp Epidemiol 2014;00(0):1–9

Type
Original Articles
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Rapid, Highly Discriminatory Binary Genotyping to Demonstrate Methicillin-Resistant Staphylococcus aureus Transmission in a Tertiary Care Intensive Care Unit
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