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Predictors of methicillin-resistant Staphylococcus aureus colonization at hospital admission

      Background

      The best strategy for active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) remains unclear. We attempted to identify a risk factor score to predict MRSA colonization at hospital admission.

      Methods

      Data on 9 variables reported as risk factors for MRSA colonization were analyzed, and a risk factor score to predict MRSA colonization was generated using multivariable logistic regression and receiver operating characteristic curve analyses. This risk score was then prospectively validated.

      Results

      Four risk factors (nursing home residence, diabetes, hospitalization in the past year, and chronic skin condition/infection) were significantly associated with MRSA colonization (c-statistic = 0.846). A cut-off score of 8 or greater would result in screening 20% of admissions and would detect 71% of MRSA-colonized patients. In the prospective validation study, a cut-off score of 8 or greater required screening 21% of admissions and detected 54% of MRSA. Nursing home residence was the best predictor of MRSA colonization.

      Conclusion

      A similar risk factor-based screening strategy could be used to predict MRSA colonization in other institutions. Our data support routine screening of nursing home patients at hospital admission.

      Key Words

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      References

        • Burton D.C.
        • Edwards J.R.
        • Horan T.C.
        • Jernigan J.A.
        • Fridkin S.K.
        Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007.
        JAMA. 2009; 301: 727-736
        • Kallen A.J.
        • Mu Y.
        • Bulens S.
        • Reingold A.
        • Petit S.
        • Gershman K.
        • et al.
        Health care-associated invasive MRSA infections, 2005-2008.
        JAMA. 2010; 304: 641-647
        • Davis K.A.
        • Stewart J.J.
        • Crouch H.K.
        • Florez C.E.
        • Hospenthal D.R.
        Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection.
        Clin Infect Dis. 2004; 39: 776-782
        • Muder R.R.
        • Brennen C.
        • Wagener M.M.
        • Vickers R.M.
        • Rihs J.D.
        • Hancock G.A.
        • et al.
        Methicillin-resistant staphylococcal colonization and infection in a long-term care facility.
        Ann Intern Med. 1991; 114: 107-112
        • Cosgrove S.E.
        • Qi Y.
        • Kaye K.S.
        • Harbarth S.
        • Karchmer A.W.
        • Carmeli Y.
        The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges.
        Infect Control Hosp Epidemiol. 2005; 26: 166-174
        • Engemann J.J.
        • Carmeli Y.
        • Cosgrove S.E.
        • Fowler V.G.
        • Bronstein M.Z.
        • Trivette S.L.
        • et al.
        Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection.
        Clin Infect Dis. 2003; 36: 592-598
        • Salgado C.D.
        • Farr B.M.
        What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures?.
        Infect Control Hosp Epidemiol. 2006; 27: 116-121
        • Warren D.K.
        • Guth R.M.
        • Coopersmith C.M.
        • Merz L.R.
        • Zack J.E.
        • Fraser V.J.
        Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit.
        Infect Control Hosp Epidemiol. 2006; 27: 1032-1040
        • Edmond M.B.
        • Ober J.F.
        • Bearman G.
        Active surveillance cultures are not required to control MRSA infections in the critical care setting.
        Am J Infect Control. 2008; 36: 461-463
        • Huang S.S.
        • Yokoe D.S.
        • Hinrichsen V.L.
        • Spurchise L.S.
        • Datta R.
        • Miroshnik I.
        • et al.
        Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia.
        Clin Infect Dis. 2006; 43: 971-978
        • Martinez-Capolino C.
        • Reyes K.
        • Johnson L.
        • Sullivan J.
        • Samuel L.
        • DiGiovine B.
        • et al.
        Impact of active surveillance on methicillin-resistant Staphylococcus aureus transmission and hospital resource utilisation.
        J Hosp Infect. 2009; 74: 232-237
        • Peterson L.R.
        • Hacek D.M.
        • Robicsek A.
        5 Million Lives Campaign. Case study: an MRSA intervention at Evanston Northwestern Healthcare.
        Jt Comm J Qual Patient Saf. 2007; 33: 732-738
        • Robicsek A.
        • Beaumont J.L.
        • Paule S.M.
        • Hacek D.M.
        • Thomson R.B.
        • Kaul K.L.
        • et al.
        Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals.
        Ann Intern Med. 2008; 148: 409-418
        • Bootsma M.C.
        • Diekmann O.
        • Bonten M.J.
        Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing.
        Proc Natl Acad Sci U S A. 2006; 103: 5620-5625
        • van Trijp M.J.
        • Melles D.C.
        • Hendriks W.D.
        • Parlevliet G.A.
        • Gommans M.
        • Ott A.
        Successful control of widespread methicillin-resistant Staphylococcus aureus colonization and infection in a large teaching hospital in the Netherlands.
        Infect Control Hosp Epidemiol. 2007; 28: 970-975
        • Vriens M.
        • Blok H.
        • Fluit A.
        • Troelstra A.
        • Van Der Werken C.
        • Verhoef J.
        Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey.
        Eur J Clin Microbiol Infect Dis. 2002; 21: 782-786
        • Muto C.A.
        • Jernigan J.A.
        • Ostrowsky B.E.
        • Richet H.M.
        • Jarvis W.R.
        • Boyce J.M.
        • et al.
        SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus.
        Infect Control Hosp Epidemiol. 2003; 24: 362-386
      1. Siegel J, Rhinehart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in healthcare settings; 2006. Available from: http://www.cdc.gov/hicpac/pdf/MDRO/MDROGuideline2006.pdf. Accessed April 22, 2013.

        • McGinigle K.L.
        • Gourlay M.L.
        • Buchanan I.B.
        The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus-related morbidity, mortality, and costs: a systematic review.
        Clin Infect Dis. 2008; 46: 1717-1725
        • Weber S.G.
        • Huang S.S.
        • Oriola S.
        • Huskins W.C.
        • Noskin G.A.
        • Kathleen H.
        • 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.
        Am J Infect Control. 2007; 35: 73-85
        • Brugnaro P.
        • Fedeli U.
        • Pellizzer G.
        • Buonfrate D.
        • Rassu M.
        • Boldrin C.
        • et al.
        Clustering and risk factors of methicillin-resistant Staphylococcus aureus carriage in two Italian long-term care facilities.
        Infection. 2009; 37: 216-221
        • 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
        • Morgan D.J.
        • Day H.R.
        • Furuno J.P.
        • Young A.
        • Johnson K.J.
        • Bradham D.D.
        • et al.
        Improving efficiency in active surveillance for methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at hospital admission.
        Infect Control Hosp Epidemiol. 2010; 31: 1230-1235
        • Furuno J.P.
        • Harris A.D.
        • Wright M.O.
        • McGregor J.C.
        • Richard V.A.
        • Jingkun Z.
        • Allardice G.
        • Smith A.
        • Masterton R.
        • et al.
        Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission.
        Am J Infect Control. 2004; 32: 436-440
        • Reilly J.S.
        • Stewart S.
        • Christie P.
        • Allardice G.
        • Smith A.
        • Masterton R.
        • et al.
        Universal screening for methicillin-resistant Staphylococcus aureus: interim results from the NHS Scotland pathfinder project.
        J Hosp Infect. 2010; 74: 35-41
        • Hidron A.I.
        • Kourbatova E.V.
        • Halvosa J.S.
        • Terrell B.J.
        • McDougal L.K.
        • Tenover F.C.
        • et al.
        Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage.
        Clin Infect Dis. 2005; 41: 159-166
        • Harbarth S.
        • Masuet-Aumatell C.
        • Schrenzel J.
        • Francois P.
        • Akakpo C.
        • Renzi G.
        • et al.
        Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study.
        Crit Care. 2006; 10: R25
        • Harbarth S.
        • Sax H.
        • Uckay I.
        • Fankhauser C.
        • Agostinho A.
        • Christenson J.T.
        • et al.
        A predictive model for identifying surgical patients at risk of methicillin-resistant Staphylococcus aureus carriage on admission.
        J Am Coll Surg. 2008; 207: 683-689
        • Harrell Jr., F.E.
        • Lee K.L.
        • Mark D.B.
        Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.
        Stat Med. 1996; 15: 361-387