title: Discontinuation of contact precautions for methicillin-resistant staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction.
abstract: BACKGROUND
  There have been no randomized controlled trials comparing active and passive screening for documenting clearance of colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the efficacy of active and passive screening using both culture and commercial polymerase chain reaction (PCR) for documentation of MRSA clearance and discontinuation of MRSA contact precautions (CPs).
  
  
  METHODS
  Inpatients with a history of MRSA infection or colonization enrolled between December 2010 and September 2011 were randomized to either passive (nonintervention arm; n = 202; observation with local standard of care) or active screening (intervention arm; n = 405; study staff screened using culture and commercial PCR). The primary outcome was discontinuation of CPs by trial arm based on 3 negative cultures. In the intervention arm, sensitivity, specificity, and positive and negative predictive values of the first PCR were compared to cultures.
  
  
  RESULTS
  CPs were discontinued significantly more often (rate ratio [RR], 4.1; 95% confidence interval [CI], 2.3%-7.1%) in the intervention arm, including in an intent-to-screen analysis (RR, 2.6; 95% CI, 1.5%-4.7%). The first PCR, compared to 3 cultures, detected MRSA with a sensitivity of 93.9% (95% CI, 85.4%-97.6%), a specificity of 92.0% (95% CI, 85.9%-95.6%), a positive predictive value of 86.1% (95% CI, 75.9%-93.1%), and a negative predictive value of 96.6% (95% CI, 91.6%-99.1%).
  
  
  CONCLUSIONS
  Compared to passive screening using culture methods, active screening resulted in discontinuation of MRSA CPs at a significantly higher frequency. Active screening with a single PCR would significantly increase the completion of the screening process. Clinical Trials Registration. NCT01234831.
authors.affiliation: Massachusetts General Hospital, Division of Infectious Diseases and Infection Control Unit, 55 Fruit St, Bulfinch 340, Boston, MA 02114, USA. eshenoy@partners.org
authors.forename: Erica S
authors.initials: ES
authors.lastname: Shenoy
authors.forename: Jiyeon
authors.initials: J
authors.lastname: Kim
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rosenberg
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Cotter
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis*
keywords: MRSA; clinical trial; contact precautions; infection control; isolation