title: Active surveillance of the trachea or throat for MRSA is more sensitive than nasal surveillance and a better predictor of MRSA infections among patients in intensive care.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of infection in the intensive care unit (ICU). Although surveillance culture for MRSA is recommended for ICU patients, no comparative study investigating the optimal sites and frequency of culture has been performed in this population.
  
  
  METHODS
  A prospective observational cohort study was performed in an 18-bed emergency intensive care unit (EICU) in a tertiary teaching hospital. A total of 282 patients were included. Samples for MRSA detection were obtained at the time of admission, 48 h after admission, and then weekly thereafter. All subjects were routinely monitored for the development of MRSA infection during their stay in the ICU.
  
  
  RESULTS
  MRSA colonization was detected in 129 (46%) patients over the course of the study. The sensitivity of MRSA surveillance culture was significantly higher in throat or tracheal aspirates (82%; 106/129) than in anterior nares (47%; 61/129) (P<0.001). The sensitivity of MRSA surveillance culture for subsequent MRSA infection and MRSA pneumonia was also higher in the throat/trachea (69 and 93%, respectively) than in the anterior nares (48 and 50%, respectively). The area under the curve for subsequent MRSA infection was higher in trachea/throat (0.675) than in the anterior nares (0.648); however, this difference was not significant (P>0.05). The area under the curve for MRSA pneumonia was significantly higher in trachea/throat (0.791; 95% CI, 0.739-0.837) than anterior nares (0.649; 95% CI, 0.590-0.705) (P = 0.044).
  
  
  CONCLUSIONS
  MRSA colonization was more common in the trachea/throat than in the anterior nares in ICU patients. Cultures from throat or tracheal aspirates were more sensitive and predictive of subsequent MRSA pneumonia than cultures from the anterior nares in this population.
authors.affiliation: Department of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Hee-Chang
authors.initials: HC
authors.lastname: Jang
authors.affiliation: Office for Infection Control, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Ok-Ja
authors.initials: OJ
authors.lastname: Choi
authors.affiliation: Office for Infection Control, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Gwang-Sook
authors.initials: GS
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Mi-Ok
authors.initials: MO
authors.lastname: Jang
authors.affiliation: Department of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Seung-Ji
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Jong-Hee
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Chonnam National University Medical School, Gwang-ju, Republic of Korea.
authors.forename: Byeong Jo
authors.initials: BJ
authors.lastname: Chun
authors.affiliation: Department of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, Republic of Korea; Office for Infection Control, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D015331:Cohort Studies; D006801:Humans; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009296:Nasal Cavity / Q000382:microbiology*; D010614:Pharynx / Q000382:microbiology*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D014132:Trachea / Q000382:microbiology*; D055815:Young Adult