title: Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus.
abstract: 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.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA. jfuruno@epi.umaryland.edu
authors.forename: Jon P
authors.initials: JP
authors.lastname: Furuno
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.forename: Marc-Oliver
authors.initials: MO
authors.lastname: Wright
authors.forename: David M
authors.initials: DM
authors.lastname: Hartley
authors.forename: Jessina C
authors.initials: JC
authors.lastname: McGregor
authors.forename: Holly D
authors.initials: HD
authors.lastname: Gaff
authors.forename: Joan N
authors.initials: JN
authors.lastname: Hebden
authors.forename: Harold C
authors.initials: HC
authors.lastname: Standiford
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
mesh_terms: 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*
chemical_list: D008712:Methicillin