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A Clinical History of Methicillin-Resistant Staphylococcus aureus Is a Poor Predictor of Preoperative Colonization Status and Postoperative Infections

Published online by Cambridge University Press:  02 January 2015

Judith Strymish ,
Westyn Branch-Elliman ,
Kamal M. F. Itani ,
Sandra Williams  and
Kalpana Gupta
Judith Strymish
Affiliation:
Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Westyn Branch-Elliman
Affiliation:
Department of Medicine and Hospital Epidemiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Kamal M. F. Itani
Affiliation:
Harvard Medical School, Boston, Massachusetts Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Sandra Williams
Affiliation:
Center for Organization, Leadership, and Management Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
Kalpana Gupta*
Affiliation:
Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
*
VA Boston HCS, 1400, VFW Parkway, 111 Med, West Roxbury, MA 02132 (kalpana.gupta@va.gov)
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Abstract

Objective.

In the absence of established methicillin-resistant Staphylococcus aureus (MRSA) screening programs, many centers use a history of a positive culture or a nasal screen as a surrogate for preoperative MRSA colonization status. We aimed to evaluate the test characteristics of these surrogates.

Design.

Retrospective cohort study.

Participants.

Veterans Affairs Boston Healthcare System surgical patients with a preoperative nasal MRSA polymerase chain reaction (PCR) screen.

Methods.

We assessed the performance of a history of a MRSA-positive culture or a positive nasal MRSA PCR screen during the year prior to surgery for predicting the preoperative nasal PCR screen result. The associations between MRSA history and postoperative outcomes, including MRSA cultures and infections, were also evaluated.

Results.

Among 4,238 patients, a positive MRSA culture history had a sensitivity of 19.7% (95% confidence interval [CI], 15.4%–24.8%) and positive predictive value of 57.3% for the preoperative nasal MRSA status. The specificity of MRSA culture history was 99% (95% CI, 98.5%–99.2%). Prior-year nasal MRSA screen results had similar test characteristics. A history of a MRSA-positive culture was associated with an increased risk of postoperative MRSA-positive cultures (risk ratio [RR], 3.54 [95% CI, 1.70–7.37], P< .001) but not of infections (RR, 1.71 [95% CI, 0.58–5.01]), after adjustment for preoperative nasal MRSA status, vancomycin surgical prophylaxis, surgical scrub, and age.

Conclusions.

A history of a MRSA-positive culture and a positive nasal PCR screen are poor surrogate markers of preoperative colonization status, missing at least 70% of MRSA-colonized patients. Prior-year history is also not independently associated with MRSA-related postoperative infections. Strong consideration should be given to preoperative MRSA screening in patients at high risk for surgical complications.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1113 - 1117
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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