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Collateral Benefit of Screening Patients for Methicillin-Resistant Staphylococcus aureus at Hospital Admission: Serendipitous Isolation of Patients with Other Multidrug-Resistant Organisms

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Surveillance at hospital admission for gram-positive and gram-negative multidrug-resistant (MDR) organisms (MDROs) is not routinely performed, potentially leaving patients carrying these organisms unrecognized.  Veterans Affairs (VA) facilities routinely screen all admissions for methicillin-resistant Staphylococcus aureus(MRSA) and place positive patients in Contact Precautions.  We assessed how often patients with other MDRO-positive clinical cultures within 30 days following hospital admission might already be in Contact Precautions because of a positive MRSA admission screen.  

Methods: MRSA nasal PCR screening and clinical culture results for MDROs were extracted from a nationwide microbiology laboratory database of patients admitted to VA acute care medical facilities from October 2007 through September 2013.  

Results: For patients admitted with a positive MRSA screen, the odds ratio of having an MDRO recovered in a clinical culture within 30 days following admission was 4.5 (95% confidence interval [CI] 4.5-4.6) compared to patients without a positive MRSA nasal screen.  The odds ratios were 2.3 (95% CI: 2.1-2.4) for vancomycin-resistant Enterococci, 2.4 (95% CI: 2.3-2.5) for MDR-Enterobacteriaceae (including extended-spectrum β-lactamase producing and carbapenem-resistant bacteria), 2.7 (95% CI: 2.5-2.9) for MDR-Pseudomonas aeruginosa (including carbapenem-resistant organisms), and 4.2 (95% CI: 3.7-4.7) for MDR-Acinetobacter spp. (including carbapenem-resistant organisms). Twenty-nine to 45% of admissions with MDROs (by species) recovered from clinical cultures within 30 days following admission had positive MRSA nasal screens and could have been in Contact Precautions since admission.  This increased to 37% to 55% (by species) if patients with an MDRO in the past year were also included.

Conclusion: Screening for MRSA nasal carriage and isolation of positive patients at hospital admission may provide a collateral benefit for the control of other MDROs.

Makoto Jones, MD, MS1, Christopher Nielson, MD, MPH2, Kalpana Gupta, MD, MPH3, Karim Khader, PhD1 and Martin Evans, MD4, (1)Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (2)Office of Patient Care Services, Veterans Healthcare System, Reno, NV, (3)Department of Medicine/Boston University School of Medicine, Boston, MA, (4)Internal Medicine, University of Kentucky, Lexington, KY

Disclosures:

M. Jones, None

C. Nielson, None

K. Gupta, None

K. Khader, None

M. Evans, None

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