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Improving Efficiency in Active Surveillance for Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococcus at Hospital Admission

Published online by Cambridge University Press:  02 January 2015

Daniel J. Morgan ,
Hannah R. Day ,
Jon P Furuno ,
Atlisa Young ,
J. Kristie Johnson ,
Douglas D. Bradham  and
Eli N. Perencevich
Daniel J. Morgan*
Affiliation:
Veterans Affairs Maryland Healthcare System, Baltimore, Maryland Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Hannah R. Day
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Jon P Furuno
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Atlisa Young
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
Douglas D. Bradham
Affiliation:
Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas–Wichita, Wichita, Kansas Robert J Dole Veterans Affairs Medical Center, Wichita, Kansas
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland Divisions of General Internal Medicine and Infectious Diseases, University of Iowa Carver College of Medicine, Wichita, Kansas Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
*
685 West Baltimore Street, MSTF 334, Baltimore, MD 21201, (dmorgan@epi.umaryland.edu)
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Abstract

Objective.

Mandatory active surveillance culturing of all patients admitted to Veterans Affairs (VA) hospitals carries substantial economic costs. Clinical prediction rules have been used elsewhere to identify patients at high risk of colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE). We aimed to derive and evaluate the clinical efficacy of prediction rules for MRSA and VRE colonization in a VA hospital.

Design and Setting.

Prospective cohort of adult inpatients admitted to the medical and surgical wards of a 119-bed tertiary care VA hospital.

Methods.

Within 48 hours after admission, patients gave consent, completed a 44-item risk factor questionnaire, and provided nasal culture samples for MRSA testing. A subset provided perirectal culture samples for VRE testing.

Results.

Of 598 patients enrolled from August 30, 2007, through October 30, 2009, 585 provided nares samples and 239 provided perirectal samples. The prevalence of MRSA was 10.4% (61 of 585) (15.0% in patients with and 5.6% in patients without electronic medical record (EMR)-documented antibiotic use during the past year; P < .01). The prevalence of VRE was 6.3% (15 of 239) (11.3% in patients with and 0.9% in patients without EMR-documented antibiotic use; P < .01 ). The use of EMR-documented antibiotic use during the past year as the predictive rule for screening identified 242.8 (84%) of 290.6 subsequent days of exposure to MRSA and 60.0 (98%) of 61.0 subsequent days of exposure to VRE, respectively. EMR documentation of antibiotic use during the past year identified 301 (51%) of 585 patients as high-risk patients for whom additional testing with active surveillance culturing would be appropriate.

Conclusions.

EMR documentation of antibiotic use during the year prior to admission identifies most MRSA and nearly all VRE transmission risk with surveillance culture sampling of only 51% of patients. This approach has substantial cost savings compared with the practice of universal active surveillance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1230 - 1235
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a metaanalysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
2.DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-suscep-tible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.CrossRefGoogle ScholarPubMed
3.Hidron, AI, Edwards, JR, Patel, J, et al.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;29:996–1011.CrossRefGoogle Scholar
4.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
5.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.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;148:409–418.CrossRefGoogle ScholarPubMed
7.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10 suppl 2):S65–S164.CrossRefGoogle Scholar
8.Weber, SG, Huang, SS, Oriolą S, et al.Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the joint SHEA and APIC task force. Infect Control Hosp Epidemiol 2007;28:249–260.CrossRefGoogle ScholarPubMed
9.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;31:42–46.CrossRefGoogle Scholar
10.Furuno, JP, McGregor, JC, Harris, AD, et al.Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166: 580–585.CrossRefGoogle ScholarPubMed
11.Riedel, S, Von Stein, D, Richardson, K, et al.Development of a prediction rule for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus carriage in a Veterans Affairs medical center population. Infect Control Hosp Epidemiol 2008;29:969–971.CrossRefGoogle Scholar
12.Kussman, MJ. Methicillin-resistant Staphylococcus aureus (MRSA) initiative. VHA directive 2007-002. Washington, DC: Department of Veterans Affairs, Veterans Health Administration, 2007.Google Scholar
13.Diekema, DJ, Edmond, MB. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007;44:1101–1107.Google ScholarPubMed
14.Haley, CC, Mittal, D, Laviolette, A, Jannapureddy, S, Parvez, N, Haley, RW. Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing. J Clin Microbiol 2007;45:3031–3038.CrossRefGoogle ScholarPubMed
15.Harbarth, S, Sax, H, Fankhauser-Rodriguez, C, Schrenzel, J, Agostinho, A, Pittet, D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 2006;119:275.e15-275.e23.CrossRefGoogle ScholarPubMed
16.Furuno, JP, Harris, AD, Wright, MO, et al.Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28:666–670.CrossRefGoogle ScholarPubMed
17.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:126–132.CrossRefGoogle ScholarPubMed
18.Muto, CA, Giannetta, ET, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:429–435.CrossRefGoogle ScholarPubMed
19.Consumer Price Index. US Department of Labor, Bureau of Labor Statistics website, http://www.bls.gov/cpi/home.htm. Published January 2010. Accessed June 4, 2010.Google Scholar
20.Metlay, JP, Hardy, C, Strom, BL. Agreement between patient self-report and a Veterans Affairs national pharmacy database for identifying recent exposures to antibiotics. Pharmacoepidemiol Drug Saf 2003;12:9–15.CrossRefGoogle Scholar
21.Johnson, JK, Khoie, T, Shurland, S, Kreisel, K, Stine, OC, Roghmann, MC. Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus USA300 clone. Emerg Infect Dis 2007;13:1195–1200.CrossRefGoogle ScholarPubMed
22.Tracy, LA, Roghmann, MC, Furuno, JP, Harris, AD, Langenberg, P, Singer, M. Incidence of invasive Staphylococcus aureus infections in the VA Maryland Healthcare System (VAMHCS): a 10-year retrospective surveillance study. Poster presented at: 49th annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 12-15,2009; San Francisco, CA.Google Scholar