Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission.
BACKGROUND
In 2003, the Society of Healthcare Epidemiology of America (SHEA) recommended surveillance cultures upon hospital admission for patients at high risk for carriage of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to assess the validity of factors from past medical history in defining patients at high risk for subsequent positive cultures with VRE or MRSA upon hospital admission.


METHODS
Subjects were adult inpatients admitted to nonintensive care wards of the index hospital during 2001-2002. Cases had MRSA or VRE positive clinical cultures within 48 hours of hospital admission. Patients with previous history of MRSA or VRE were excluded.


RESULTS
Nineteen thousand three hundred ninety-nine patients were included, with 273 cases of VRE or MRSA. Previous admission within 1 year of current admission had a sensitivity of 56.8% and a specificity of 88.4% for predicting a case of MRSA or VRE. Individually, the sensitivity and specificity for admission within the past year were 50.5% and 88.4%, respectively, for MRSA and 76.9% and 88.4%, respectively, for VRE.


CONCLUSIONS
Patients with a previous hospital admission represent a high-risk population for positive culture for VRE and MRSA and may be a group of which active surveillance is indicated.
Furuno
Jon P
JP
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 100 N. Greene Street, Baltimore, MD 21201, USA. jfuruno@epi.umaryland.edu
Harris
Anthony D
AD
Wright
Marc-Oliver
MO
McGregor
Jessina C
JC
Venezia
Richard A
RA
Zhu
Jingkun
J
Perencevich
Eli N
EN
D000328:Adult; D000368:Aged; D000465:Algorithms; D016983:Enterococcus / Q000187:drug effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects*; D020713:Vancomycin Resistance