Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-28T02:04:54.430Z Has data issue: false hasContentIssue false
  • English
  • Français

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)
Get access Rights & Permissions [Opens in a new window]

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

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.Diekema, D, Johannsson, B, Herwaldt, L, et al.Current practice in Staphylococcus aureus screening and decolonization. Infect Control Hosp Epidemiol 2011;32(10):1042–1044.CrossRefGoogle ScholarPubMed
2.Kluytmans, JAJW, Mouton, JW, Ijzerman, EP, et al.Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995;171(1):216–219.Google Scholar
3.Bode, LGM, Kluytmans, JAJW, Wertheim, HFL, et al.Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362(1):9–17.CrossRefGoogle ScholarPubMed
4.Gupta, K, Strymish, J, Abi-Haidar, Y, Williams, SA, Itani, KM. Preoperative nasal methicillin-resistant Staphylococcus aureus status, surgical prophylaxis, and risk-adjusted postoperative outcomes in veterans. Infect Control Hosp Epidemiol 2011;32(8):791–796.Google ScholarPubMed
5.Anderson, DJ, Kaye, KS, Classen, D, et al.Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S51–S61.Google ScholarPubMed
6.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(6):1123–1128.CrossRefGoogle ScholarPubMed
7.Schweizer, ML, Furuno, JP, Harris, AD, et al.Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremia. BMC Infect Dis 2011;11:279, doi:10.1186/1471-2334-11-279.Google ScholarPubMed
8.Wolk, DM, Picton, E, Johnson, D, et al.Multicenter evaluation of the Cepheid Xpert methicillin-resistant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares. J Clin Microbiol 2009;47(3):758–764.Google ScholarPubMed
9.de San, N, Denis, O, Gasasira, MF, De Mendonca, R, Nonhoff, C, Struelens, MJ. Controlled evaluation of the IDI-MRSA assay for detection of colonization by methicillin-resistant Staphylococcus aureus in diverse mucocutaneous specimens. J Clin Microbiol 2007;45(4):1098–1101.Google ScholarPubMed
10.Olchanski, N, Mathews, C, Fusfeld, L, Jarvis, W. Assessment of the influence of test characteristics on the clinical and cost impacts of methicillin-resistant Staphylococcus aureus screening programs in US hospitals. Infect Control Hosp Epidemiol 2011;32(3):250–257.Google ScholarPubMed
11.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):42–46.CrossRefGoogle Scholar
12.Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32(10):1393–1398.CrossRefGoogle ScholarPubMed
13.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(10):1149–1157.CrossRefGoogle ScholarPubMed
14.Schweizer, ML, Furuno, JP, Harris, AD, et al.Clinical utility of infection control documentation of prior methicillin-resistant Staphylococcus aureus colonization or infection for optimization of empirical antibiotic therapy. Infect Control Hosp Epidemiol 2008;29(10):972–974.CrossRefGoogle ScholarPubMed
15.Salgado, 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):116–121.CrossRefGoogle ScholarPubMed
16.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):1419–1430.Google ScholarPubMed