title: An antibiotic care bundle approach based on results of rapid molecular screening for nasal carriage of methicillin-resistant Staphylococcus aureus in the intensive care unit.
abstract: The potential role of active methicillin-resistant Staphylococcus aureus (MRSA) surveillance in the intensive care unit (ICU), has been recently proposed as a guide for antibiotic treatment in patients suspected of being infected with MRSA by using an antibiotic care bundle (ACB) approach. A group of 376 consecutive ICU patients were prospectively screened for nasal carriage of MRSA using a real-time polymerase chain reaction test. The study group consisted of 244 (64.9%) males and (35.1%) females, with a median age of 64 (range 17-95 years). Overall, 26 (6.9%) patients were positive for MRSA, while 350 (93.1%) were MRSA-negative. No difference was observed in gender and age between groups. During ICU stay, 9 (2.4%) patients developed generalized MRSA infection, of whom 8 out of 26 (30.8%) were MRSA-carriers and one out of the 350 (0.3%) was MRSA-negative. Thus, a strong relationship between MRSA infection and MRSA carriage (relative risk=107.7, 95% confidence interval=14.0-828.5, p<0.0001) was found. Subsequently, in our ICU, we developed and introduced a new ACB approach based on rapid nasal screening results for improving the management of critically ill patients. The use of anti-MRSA agents should be re-evaluated daily on the basis of clinical and laboratory features, with positive cultures from sterile site or signs of active infection supporting prolongation of empirical treatment. On the contrary, MRSA-negative clinical cultures support a de-escalation strategy. In conclusion, the early identification of MRSA-carriers using a rapid molecular screening is safe and accurate, allowing MRSA-positive patients, who will more likely develop MRSA infections, to be detected.
authors.affiliation: Department of Microbiology and Virology, S. Maria degli Angeli Hospital, Via Montereale 24, 33170 Pordenone, Italy. paola.stano@aopn.fvg.it
authors.forename: Paola
authors.initials: P
authors.lastname: Stano
authors.forename: Manuela
authors.initials: M
authors.lastname: Avolio
authors.forename: Rita
authors.initials: R
authors.lastname: De Rosa
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Modolo
authors.forename: Stefano M M
authors.initials: SM
authors.lastname: Basso
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Camporese
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics*; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D057089:Pathology, Molecular; D011159:Population Surveillance; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014640:Vancomycin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid