Journal article
Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units
The Journal of infectious diseases, Vol.195(3), pp.330-338
02/01/2007
DOI: 10.1086/510622
PMID: 17205470
Abstract
Routine culturing of patients in intensive care units (ICUs) for methicillin-resistant Staphylococcus aureus (MRSA) identifies unrecognized carriers and facilitates timely isolation. However, the benefit of surveillance in detecting prevalent and incident carriers likely varies among ICUs. In addition, many assessments underestimate the incidence of acquisition by including prevalent carriers in the at-risk population.
We performed a retrospective cohort study using accurate at-risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting otherwise unrecognized MRSA in 12 ICUs in 5 states.
We assessed 142 ICU-months. Among the 12 ICUs, the admission prevalence of imported MRSA was 5%-21%, with admission surveillance providing 30%-135% increases in rates of detection. The monthly hospital-associated incidence was 2%-6%, with weekly surveillance providing 7%-157% increases in detection. The common practice of reporting incidence using the total number of patients or total patient-days underestimated incidence by one-third. Surgical ICUs had lower MRSA importation but higher MRSA incidence. Overall, routine surveillance prevented the misclassification of 17% (unit range, 11%-29%) of "incident" carriers, compared with clinical cultures, and increased precaution days by 18% (unit range, 11%-91%).
Routine surveillance significantly increases the detection of MRSA, but this benefit is not uniform across ICUs, even with high compliance and the use of correct denominators.
Details
- Title: Subtitle
- Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units
- Creators
- Susan S Huang - Brigham and Women's Hospital, Channing Laboratory and Infection Control Department, Harvard Medical School, and Harvard Pilgrim Health Care, Boston, MA 02115, USA. sshuang@partners.orgSheryl L Rifas-ShimanDavid K WarrenVictoria J FraserMichael W ClimoEdward S WongSara E CosgroveTrish M PerlJean M PottingerLoreen A HerwaldtJohn A JerniganJerome L TokarsDaniel J DiekemaVirginia L HinrichsenDeborah S YokoeRichard Platt
- Contributors
- Centers for Disease Control and Prevention Epicenters Program
- Resource Type
- Journal article
- Publication Details
- The Journal of infectious diseases, Vol.195(3), pp.330-338
- Publisher
- United States
- DOI
- 10.1086/510622
- PMID
- 17205470
- ISSN
- 0022-1899
- eISSN
- 1537-6613
- Grant note
- K23 AI64161-01 / NIAID NIH HHS
- Language
- English
- Date published
- 02/01/2007
- Academic Unit
- Infectious Diseases; Epidemiology; Pathology; Internal Medicine
- Record Identifier
- 9983986366502771
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