We evaluated the use of the BD GeneOhm MRSA real-time PCR assay (BD Diagnostics, San Diego, CA) for the detection of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA). The initial evaluation consisted of 403 paired nasal swabs and was done using the specimen preparation provided with the kit and an in-house lysis method that was specifically developed to accommodate large-volume testing using a minimal amount of personnel time. One swab was placed in an achromopeptidase (ACP) lysis solution, and the other was first used for culture and then prepared according to the kit protocol. PCR was performed on both lysates, and results were compared to those for culture. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PCR assay were 98%, 96%, 77%, and 99.7% with the kit lysate and 98%, 95%, 75%, and 99.7% with the ACP lysate (P, not significant), respectively. The second evaluation was done after implementation of all-admission surveillance using PCR with ACP lysis and a sampling of 1,107 PCR-negative samples and 215 PCR-positive samples that were confirmed by culture. The results of this sampling showed an NPV of 99.9% and a PPV of 73.5% (prevalence, 6%), consistent with our initial findings. The BD GeneOhm MRSA assay is an accurate and rapid way to detect MRSA nasal colonization. When one is dealing with large specimen numbers, the ACP lysis method offers easier processing without negatively affecting the sensitivity or specificity of the PCR assay.
Background Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea. Objective Assess the impact of admission testing for toxigenic C. difficile colonization on the incidence of HO-CDI.
The ten-dose regimen is superior to any six-dose regimen for de-colonizing S. aureus from the anterior nares of patients and for maintaining the decolonized state for at least four weeks after therapy.
BackgroundSurveillance for asymptomatic carriage of multidrug-resistant (MDR) pathogens is useful to determine the burden of these organisms and help guide infection prevention strategy. We currently perform surveillance cultures for Gram-negative multidrug-resistant pathogens (GNMDR) in the ICUs on a monthly basis. We added a quarterly point prevalence survey to all hospital units for these and other key pathogens over one year to determine whether our program should expand beyond the ICU and include other organisms.MethodsRectal samples were collected quarterly for 1 year starting June 2016 at NorthShore University HealthSystem, a four-hospital, 789 bed system. All hospitalized patients present on the day of the point prevalence testing had a double-headed rectal swab collected. One swab was plated to VACC agar (Remel) for culture of GNMDR and VRE, and the second was plated to CCFAHT (Anaerobe Systems) for C. difficile (Cdif) culture. All samples were collected on a specified day at each of our 4 hospitals, one hospital per week, and sent to the central microbiology lab for processing. Testing for GNMDR included the following pathogens: Carbapenem-resistant Enterobacteriaceae (CRE), ESBLs, and Gram negative organisms susceptible to ≤2 drug classes.ResultsA total of 987 surveillance samples were collected. The number of patients with MDR in the ICU vs. non-ICU units is described in Table 1. There was an 11% greater difference in the percentage of patients colonized with GNMDR and Cdif in non-ICU patients compared with ICU patients (P = 0.006). An important discovery was three patients colonized with CRE outside the ICU that were previously unknown. The burden of ESBL, VRE and Cdif carriage was also greater outside the ICU.Table 1.Comparison of Patients in ICU vs. Non-ICU with Important Hospital PathogensNumber of Patients With:No. TestsImportant Pathogens (%)ESBLCREMDRVREToxigenic CdifNon-ICU833175 (21%)79356447ICU15417 (11%)102117ConclusionThe point prevalence surveillance uncovered a significant amount of MDRs in our non-ICU units, particularly three CREs that were previously unknown. These results suggest there is a large burden of MDR organisms outside the ICU.Disclosures All authors: No reported disclosures.
Background:Candida auris prevalence in Illinois, particularly in the metropolitan Chicago area, is high. The Illinois Department of Public Health recommends empiric contact precautions for patients with a tracheostomy or requiring mechanical ventilation from skilled nursing facilities (vSNFs) or long-term acute-care hospitals (LTACHs) who are admitted to an acute-care hospital. Cases of C. auris infection and colonization are reportable to the Illinois Extensively Drug Resistant Organism Registry (XDRO Registry). NorthShore University HealthSystem (NSUHS) actively screens adult intensive care unit (ICU) admissions from LTACHs and vSNFs for CA. Methods: NSUHS is a 4-hospital system located north of Chicago with 750 beds, 4 ICUs and ∼64,000 annual admissions. Beginning in April 2019, a composite axilla–groin swab was collected from all ICU LTACH or vSNF admissions. Composite swabs are cultured on Inhibitory Mold Agar. In July 2019, an ICU clinical case of C. auris was identified from a ventilated patient admitted from an outside hospital prompting the expansion of screening to include acute-care hospital transfers. To evaluate the value of screening criteria, a medical record review and retrospective query of the XDRO Registry was performed for all screened patients. Because cocolonization with carbapenemase-producing organisms (CPO) has been reported, CPO status was also queried. Results: Between April 1 and October 31, 2019, 70 patients were screened. Two screened patients did not meet the screening criteria (Fig. 1). No patients, with the exception of the clinical case, were found to be colonized with CA. The XDRO Registry query identified no patients with C. auris. Of the 70 patients, 9 (13%) had a CPO. Of those screened, 14 (20%) had a tracheostomy and/or mechanical ventilation (Table 1). Conclusions: Querying the XDRO registry at admission in combination with a medical record review appears adequate to identify patients admitted to a NSUHS ICU with C. auris and CPOs. Targeting patients admitted with a tracheostomy and/or mechanical ventilation may further reduce the number of screening cultures performed.Funding: NoneDisclosures: None
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