title: Targeted surveillance of methicillin-resistant Staphylococcus aureus and its potential use to guide empiric antibiotic therapy.
abstract: The present study aimed to determine the frequency of methicillin-resistant Staphylococcus aureus (MRSA)-positive clinical culture among hospitalized adults in different risk categories of a targeted MRSA active surveillance screening program and to assess the utility of screening in guiding empiric antibiotic therapy. We completed a prospective cohort study in which all adults admitted to non-intensive-care-unit locations who had no history of MRSA colonization or infection received targeted screening for MRSA colonization upon hospital admission. Anterior nares swab specimens were obtained from all high-risk patients, defined as those who self-reported admission to a health care facility within the previous 12 months or who had an active skin infection on admission. Data were analyzed for the subcohort of patients in whom an infection was suspected, determined by (i) receipt of antibiotics within 48 h of admission and/or (ii) the result of culture of a sample for clinical analysis (clinical culture) obtained within 48 h of admission. Overall, 29,978 patients were screened and 12,080 patients had suspected infections. A total of 46.4% were deemed to be at high risk on the basis of the definition presented above, and 11.1% of these were MRSA screening positive (colonized). Among the screening-positive patients, 23.8% had a sample positive for MRSA by clinical culture. Only 2.4% of patients deemed to be at high risk but found to be screening negative had a sample positive for MRSA by clinical culture, and 1.6% of patients deemed to be at low risk had a sample positive for MRSA by clinical culture. The risk of MRSA infection was far higher in those who were deemed to be at high risk and who were surveillance culture positive. Targeted MRSA active surveillance may be beneficial in guiding empiric anti-MRSA therapy.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 685 W. Baltimore St., Room 330, Baltimore, MD 21201, USA. aharris@epi.umaryland.edu
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.forename: Jon P
authors.initials: JP
authors.lastname: Furuno
authors.forename: Mary-Claire
authors.initials: MC
authors.lastname: Roghmann
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Johnson
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Conway
authors.forename: Richard A
authors.initials: RA
authors.lastname: Venezia
authors.forename: Harold C
authors.initials: HC
authors.lastname: Standiford
authors.forename: Marin L
authors.initials: ML
authors.lastname: Schweizer
authors.forename: Joan N
authors.initials: JN
authors.lastname: Hebden
authors.forename: Anita C
authors.initials: AC
authors.lastname: Moore
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015142:Baltimore / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents