title: Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria.
abstract: BACKGROUND
  Surveillance at hospital admission for multidrug-resistant (MDR) gram-negative bacteria (GNB) is not often performed, potentially leaving patients carrying these organisms unrecognized and not placed in transmission precautions until they develop infection. Veterans Affairs (VA) facilities screen all admissions for methicillin-resistant Staphylococcus aureus (MRSA) and place positive patients in contact precautions. We assessed how often patients with MDR GNB in clinical cultures obtained within 30 days following admission would have been in contact precautions because of a positive MRSA admission screen.
  
  
  METHODS
  MRSA screening and MDR GNB culture results were extracted from a database of patients admitted to all VA acute care medical facilities from January 2009-December 2012.
  
  
  RESULTS
  Of patients with MDR GNB-positive cultures within 30 days following admission, up to 44.3% (dependent on bacterial species) would have been in contact precautions because of a clinical positive admission MRSA nasal screen. Admissions with a positive MRSA screen had odds for MDR GNB in a culture 2.5 times greater than those with a negative screen (95% confidence interval [CI], 2.4-2.6). Odds ratios were 2.4 (95% CI, 2.3-2.5) for MDR Enterobacteriaceae, 2.7 (95% CI, 2.5-2.9) for MDR Pseudomonas aeruginosa, and 4.3 (95% CI, 3.8-4.8) for MDR Acinetobacter spp.
  
  
  CONCLUSIONS
  Patients may be serendipitously placed in contact precautions for MDR GNB when isolated for a positive admission MRSA screen.
authors.affiliation: Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT; Department of Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.affiliation: Veterans Affairs Reno Medical Center, Reno, NV; Department of Internal Medicine, University of Nevada, Reno, NV.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nielson
authors.affiliation: Department of Veterans Affairs, Boston Veterans Affairs Health Care System, National Center for Occupational Health and Infection Control, Office of Public Health, Boston, MA; Department of Internal Medicine, Boston University, Boston, MA.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Gupta
authors.affiliation: Department of Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Karim
authors.initials: K
authors.lastname: Khader
authors.affiliation: Department of Veterans Affairs, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Veterans Health Administration, Washington, DC; Lexington Veterans Affairs Medical Center, Lexington, KY; Department of Internal Medicine, University of Kentucky, Lexington, KY. Electronic address: martin.evans@va.gov.
authors.forename: Martin
authors.initials: M
authors.lastname: Evans
mesh_terms: D002353:Carrier State / Q000175:diagnosis / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control; D003955:Diagnostic Tests, Routine / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology
keywords: Carbapenem-resistant Enterobacteriaceae; Contact precautions; Enterobacteriaceae; Infection control; MDRO; MRSA; Pseudomonas aeruginosa Acinetobacter; Screening