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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
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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

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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