1063. Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection (BSI) Surveillance: National Healthcare Safety Network’s (NHSN) Laboratory-Identified (LabID) Event versus Traditional Surveillance
Session: Poster Abstract Session: Surveillance of HAIs: Evaluating National Strategy
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • A Baker poster.pdf (2.0 MB)
  • Background:

    Hospitals began using the NHSN’s new LabID event reporting module for BSI due to MRSA in January 2013.  Comparison of LabID surveillance for MRSA BSI and traditional surveillance methods based on the NHSN’s Laboratory-Confirmed Bloodstream Infection (LCBI) protocol has not previously been described.

    Methods:

    We performed parallel surveillance using LabID and traditional LCBI surveillance for MRSA BSI at 28 community hospitals over a three-month time period (1/2013-3/2013).  Both surveillance methods characterized MRSA BSI as healthcare facility-onset (HO) or community-onset (CO) based upon the relative dates of admission and positive blood cultures.  We divided cases categorized as CO by traditional surveillance as community-onset, healthcare-associated (HCA) BSI or community-acquired (CA) BSI by evaluating healthcare-exposure risk factors.

    Results:

    In total, 157 cases of MRSA BSI were identified over 298,527 patient-days (pt-d).  LabID surveillance categorized 13 (8%) cases as HO and 144 (92%) cases as CO.  In contrast, traditional surveillance designated 19 (12%) BSI as HO, 101 (64%) as HCA, and 35 (22%) as CA; 6 (4%) discordant cases were designated as HO by traditional surveillance and CO by LabID.  As a result, the rate of MRSA HO-BSI was 32% lower for LabID versus traditional surveillance (4.35 vs. 6.36 per 100,000 pt-d).  4 of the discordant cases had positive blood cultures on day 3 of admission, but LabID BSI are not considered HO until day 4.  The other 2 discordant cases involved BSI in patients who were readmitted within 48 hours of discharge.  Traditional surveillance did not identify any HCA or CA cases considered HO by LabID with delayed diagnosis based upon symptom onset prior to day 3.

    Conclusion:

    LabID event reporting requires less labor than traditional surveillance and provides prompt characterization of MRSA BSI as HO or CO.  Only 4% of cases were discordant between the two surveillance methods; however, these cases led to a decrease in rate of MRSA HO-BSI.  LabID surveillance does not distinguish HCA BSI from CA cases, limiting its utility to hospital infection control programs evaluating for reservoirs of MRSA in the community.

    Arthur W. Baker, MD1, Rebekah W. Moehring, MD, MPH2, Luke F. Chen, MBBS, MPH, CIC, FRACP1, Sarah S. Lewis, MD1, Kristen V. Dicks, MD1, Michael J. Durkin, MD1, Daniel J. Sexton, MD, FIDSA1 and Deverick J. Anderson, MD, MPH3, (1)Duke University Medical Center, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC

    Disclosures:

    A. W. Baker, None

    R. W. Moehring, None

    L. F. Chen, None

    S. S. Lewis, None

    K. V. Dicks, None

    M. J. Durkin, None

    D. J. Sexton, None

    D. J. Anderson, None

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