title: Methicillin-resistant Staphylococcus aureus infection rate after implementation of an antibiotic care bundle based on results of rapid molecular screening.
abstract: OBJECTIVE
  Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for subsequent invasive MRSA infection, particularly in patients admitted to critical areas. We conducted a surveillance among patients admitted to our Intensive Care Unit (ICU) to determine whether the implementation of a specific MRSA antibiotic care bundle (ACB) based on rapid molecular screening for MRSA and de-colonization, reduced the total MRSA infection rate.
  
  
  METHODS
  A total of 431 and 577 nasal swabs were obtained from ICU patients at admission from April 2009 through December 2010 (pre-ACB period) and, after the bundle implementation, from January 2011 through December 2012 (post-ACB period), respectively. Nasal swabs were analyzed by the rapid molecular test Xpert MRSA. All patients were followed-up during their whole ICU stay to determine whether they developed MRSA infection.
  
  
  RESULTS
  Overall, 31 out of 431 (7.1%) patients were colonized with MRSA at admission during the pre-ACB period and 49 out of 577 (8.4%) were colonized with MRSA during the post-ACB period. The rate of MRSA infection in ICU significantly declined from 2% in pre-ACB to 0.3% in post-ACB, with a total decrease of 100% in two consecutive semesters between July 2011 and July 2012 (p<0.001).
  
  
  CONCLUSIONS
  The analysis demonstrated a significant decline in MRSA infections following the introduction of active rapid molecular surveillance and the specific ACB at our ICU and in the risk associated with MRSA bacteremia.
authors.affiliation: Microbiology and Virology Department, S. Maria degli Angeli Hospital, Via Montereale 24 - 33170, Pordenone, Italy. paola.stano@aopn.sanita.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: Alessandro
authors.initials: A
authors.lastname: Camporese
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus; D025202:Molecular Diagnostic Techniques; D009666:Nose / Q000382:microbiology; D064872:Patient Care Bundles; D015995:Prevalence; D012306:Risk; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Rapid molecular screening; Staphylococcus aureus; infection prevention; methicillin-resistant; nosocomial infection