Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus.
OBJECTIVE
To quantify the value of performing active surveillance cultures for detection of methicillin-resistant Staphylococcus aureus (MRSA) on intensive care unit (ICU) discharge.


METHODS
Prospective cohort study.


METHODS
Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.


METHODS
We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.


RESULTS
Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.


CONCLUSIONS
Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.
Furuno
Jon P
JP
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA. jfuruno@epi.umaryland.edu
Harris
Anthony D
AD
Wright
Marc-Oliver
MO
Hartley
David M
DM
McGregor
Jessina C
JC
Gaff
Holly D
HD
Hebden
Joan N
JN
Standiford
Harold C
HC
Perencevich
Eli N
EN
D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D015331:Cohort Studies; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008712:Methicillin / Q000494:pharmacology; D016106:Methicillin Resistance; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D010351:Patient Discharge; D015397:Program Evaluation; D011446:Prospective Studies; D018571:Sentinel Surveillance; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
D008712:Methicillin