The use of a critical care consult team to identify risk for methicillin-resistant Staphylococcus aureus infection and the potential for early intervention: a pilot study.
OBJECTIVE
To test whether a critical care consult team can be used to identify patients who have methicillin-resistant Staphylococcus aureus nasal colonization during a window period at which they are at highest risk for methicillin-resistant S. aureus infection and can most benefit from topical decolonization strategies.


METHODS
Prospective cohort study.


METHODS
Two adult tertiary care hospitals.


METHODS
Patients with at least one risk factor for methicillin-resistant S. aureus nasal colonization who were seen by a critical care consult team for potential intensive care unit admission were enrolled.


METHODS
Nasal cultures for methicillin-resistant S. aureus were performed on all subjects. All subjects were followed for the development of a methicillin-resistant S. aureus infection for 60 days or until hospital discharge. Demographic and outcome data were recorded on all subjects.


RESULTS
Two hundred subjects were enrolled. Overall 29 of 200 (14.5%) were found to have methicillin-resistant S. aureus nasal colonization. Methicillin-resistant S. aureus infections occurred in seven of 29 (24.1%) subjects with methicillin-resistant S. aureus nasal colonization vs. one of 171 (0.6%) subjects without methicillin-resistant S. aureus nasal colonization (p < .001). Methicillin-resistant S. aureus clinical specimens were recovered in 15 of 29 (51.7%) subjects with methicillin-resistant S. aureus nasal colonization vs. two of 171 (1.2%) without methicillin-resistant S. aureus nasal colonization.


CONCLUSIONS
A critical care consult team can be used to rapidly recognize patients with methicillin-resistant S. aureus nasal colonization who are at very elevated risk for methicillin-resistant S. aureus infection. The use of such a team to recognize patients who have greatest potential benefit from decolonization techniques might reduce the burden of severe methicillin-resistant S. aureus infections.
Keene
Adam
A
Departments of Critical Care Medicine and Pathology, Montefiore Medical Center, Bronx, NY, USA. akeene@montefiore.org
Lemos-Filho
Luciano
L
Levi
Michael
M
Gomez-Marquez
Jose
J
Yunen
Jose
J
Said
Hayder
H
Lowy
Franklin D
FD
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011336:Probability; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents