title: MRSA screening on a paediatric intensive care unit.
abstract: The accuracies of chromogenic agar and the GeneXpert real-time PCR system (Cepheid, Sunnyvale, California, USA) for admission methicillin-resistant Staphylococcus aureus (MRSA) screening of 1336 consecutive paediatric intensive care unit patients (1282 evaluable swab results) were determined using enrichment culture as the reference standard. Twenty (1.6%) swabs were MRSA-positive by enrichment culture (reference test). PCR was more sensitive (0.9, 95% CI 0.68 to 0.99 vs 0.65, 95% CI 0.41 to 0.85) but less specific (0.98, 95% CI 0.98 to 0.99 vs 100%) than chromogenic agar. After introduction of screening no patient developed MRSA infection or acquired MRSA after admission. In the preceding 3 years of screening, 16 patients had MRSA diagnosed after admission, nine presenting with infection. The accuracy of PCR was comparable to previous studies, but the positive predictive value in a low prevalence paediatric population was only 0.49. Screening provided some clinical benefits, to which the early availability of PCR results may have contributed.
authors.affiliation: Department of Microbiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. jim.gray@bch.nhs.uk
authors.forename: James
authors.initials: J
authors.lastname: Gray
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.forename: Helen
authors.initials: H
authors.lastname: Turner
authors.forename: Fiona
authors.initials: F
authors.lastname: Reynolds
mesh_terms: D015373:Bacterial Typing Techniques / Q000379:methods; D002648:Child; D002863:Chromogenic Compounds; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009296:Nasal Cavity / Q000382:microbiology; D010343:Patient Admission; D011237:Predictive Value of Tests; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D002863:Chromogenic Compounds