Impact of preoperative screening for meticillin-resistant Staphylococcus aureus by real-time polymerase chain reaction in patients undergoing cardiac surgery

Jog, Shivangi; Cunningham, Richard; Cooper, Sarah; Wallis, M. Chad; Marchbank, A.; Vasco-Knight, P.; Jenks, Peter J.

doi:10.1016/j.jhin.2008.02.008

Cited by 89 publications

(70 citation statements)

References 30 publications

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“…An active MRSA surveillance program that uses a laboratory test with 98% sensitivity and with a reporting time of Յ15 h can capture 85% of potential inpatient MRSA isolation days, leading to a significant (Ͼ70%) reduction in MRSA infection (28). For these reasons, tremendous amounts of effort and resources have been focused on the development of several new molecular-based rapid screening tests for MRSA (12)(13)(14)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

“…MRSA screening using molecular amplification methods provides faster results than culture and has been demonstrated to be more sensitive (11)(12)(13)(14)(15). However, most of the molecular commercially available rapid tests are based on the detection of a sequence indicating the integration of the staphylococcal cassette chromosome mec element (SCCmec) within the chromosome and do not specifically target the methicillin resistance gene mecA (16).…”

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confidence: 99%

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Evaluation of BD Max StaphSR and BD Max MRSA XT Assays Using ESwab-Collected Specimens

et al. 2015

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The BD Max MRSAXT and the BD Max StaphSR assays were validated for the detection of methicillin-resistant Staphylococcus aureus (MRSA) in ESwab samples. In addition, the BD Max StaphSR assay was evaluated for its ability to detect and differentiate S. aureus and MRSA in the same sample. A total of 255 ESwab samples collected from the anterior nares of patients were tested by each of three BD Max assays, including the BD Max MRSA first-generation assay. The results were compared to those of direct and enrichment culture. Additionally, a challenge panel comprising 14 control strains was evaluated to determine the ability of these assays to correctly identify MRSA and also appropriately differentiate S. Staphylococcus aureus is a leading cause of health care-associated infections. Infection due to S. aureus imposes a high and increasing burden on health care resources and increases morbidity and mortality. Nasal carriage of S. aureus has been identified as a risk factor for the development of infections in various settings. This has been studied extensively in surgical patients (general, orthopedic, and thoracic surgery), patients on hemodialysis, patients on continuous ambulatory peritoneal dialysis (CAPD), HIV-infected patients, and patients in intensive care units (1, 2). Methicillin-resistant S. aureus (MRSA) is an important cause of community-acquired and hospital-acquired infections (3, 4). MRSA can colonize the nares, skin, and other body sites, serving as a reservoir for infection and transmission in health care environments (5-7). Screening for MRSA colonization in order to help identify patients at greater risk for MRSA infection and to allow for the initiation of isolation precautions has become standard practice in many institutions (5,6,(8)(9)(10).MRSA screening using molecular amplification methods provides faster results than culture and has been demonstrated to be more sensitive (11-15). However, most of the molecular commercially available rapid tests are based on the detection of a sequence indicating the integration of the staphylococcal cassette chromosome mec element (SCCmec) within the chromosome and do not specifically target the methicillin resistance gene mecA (16). S. aureus isolates with an SCCmec lacking the mecA gene have been described and can be incorrectly identified as MRSA by assays that do not specifically target the mecA gene (17). False-positive results can lead to unnecessary and expensive isolation and treatment of patients. In addition, MRSA strains with the newly discovered methicillin resistance gene mecC account for 3 to 4% of all new MRSA cases in Denmark (18) and cannot be detected by assays that do not detect the mecC gene (19). These false-negative results can lead to uncontrolled transmission of undetected MRSA strains.The BD Max StaphSR and the BD Max MRSAXT assays (BD Diagnostics, Québec, Canada) performed on the BD Max system (BD Diagnostics, Sparks, MD) are next-generation automated qualitative in vitro diagnostic tests able to detect MRSA strains harboring the m...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Evaluation of BD Max StaphSR and BD Max MRSA XT Assays Using ESwab-Collected Specimens

et al. 2015

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“…Screening for MRSA colonization to help identify patients at greater risk for MRSA infection and to allow for initiation of isolation precautions has become standard practice in many institutions (3)(4)(5)(6)(7). Molecular amplification methods for MRSA screening of hospitalized patients provides rapid results and have been demonstrated to be more sensitive than culture-based methods (8)(9)(10)(11)(12)(13)(14)(15). The BD MAX MRSA assay (BD Diagnostics, Québec, Canada) is a molecular test performed on the BD MAX system (BD Diagnostics, Sparks, MD).…”

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confidence: 99%

Laboratory Evaluation of the BD MAX MRSA Assay

2014

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A comparison between the BD MAX MRSA and Xpert MRSA assays was performed using 239 nares samples. A 97.9% overall agreement between the two molecular assays was observed. The BD MAX MRSA assay proved to be a reliable alternative for a highly automated system to detect methicillin-resistant Staphylococcus aureus (MRSA) in patient nares samples. Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of community and hospital-acquired infections (1, 2). Screening for MRSA colonization to help identify patients at greater risk for MRSA infection and to allow for initiation of isolation precautions has become standard practice in many institutions (3-7). Molecular amplification methods for MRSA screening of hospitalized patients provides rapid results and have been demonstrated to be more sensitive than culture-based methods (8-15). The BD MAX MRSA assay (BD Diagnostics, Québec, Canada) is a molecular test performed on the BD MAX system (BD Diagnostics, Sparks, MD). The BD MAX is an automated sample-in and answer-out instrument that combines sample extraction, PCR setup, and real-time PCR on a walkaway platform. The objective of this study was to compare the BD MAX MRSA assay to the only other fully automated walkaway MRSA PCR assay, the Xpert MRSA (Cepheid, Sunnyvale, CA), performed on the GeneXpert instrument (Cepheid).A total of 239 nares samples were collected from August to September 2012 from all patients admitted to any intensive care unit (ICU) at Tampa General Hospital (TGH), using two individually collected traditional swabs (LQ Stuart; BD BBL). One of the swabs was used for the Xpert MRSA assay, and the other was tested by the BD MAX MRSA assay; both assays were performed in parallel on both instruments according to the manufacturer's instructions without the technician having knowledge of the result from either instrument. For the Xpert MRSA assay, samples were placed in the Xpert assay buffer and transferred to the Xpert MRSA cartridge for PCR on the GeneXpert 16 system (Cepheid). For the BD MAX MRSA assay, samples were placed in the BD MAX MRSA sample buffer tube, which was subjected to vortex mixing for 60 s on a multiposition vortex. Sample tubes were placed in the BD MAX system along with the extraction reagent strip and PCR cartridges. The BD MAX MRSA sample buffer supports MRSA viability, which allowed a limited set of samples to be tested by an in-housevalidated mecA and femA PCR, using previously published primers/probes (1), to address discrepant samples.The limit of detection (LOD) of each assay was assessed using a positive-control strain (MRSA, ATCC 33591). Initially, a 0.5-McFarland-standard suspension of the strain was prepared in saline using fresh colonies from a blood agar plate. The suspension was followed by a series of 10-fold dilutions in saline. Five dilutions (1 ϫ 10 3 to 1 ϫ 10 7 CFU/ml) were tested in triplicate by both the Xpert MRSA and the BD MAX MRSA assay. The highest dilution (i.e., lowest concentration) at which all three replicates were positive was cons...

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“…Nasal carriage of MRSA is considered to constitute a risk factor for SSIs in the fields of adult cardiac surgery. [16][17][18][19][20][21] In this study, the incidence of postoperative mediastinitis for patients with MRSApositive nasal cultures was much higher when compared with that for MRSA-negative patients, with an odds ratio of 16.3. Few studies have found that preoperative nasal colonization is a risk for postoperative SSIs in pediatric cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Katayanagi

2015

ATCS

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Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA)is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

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Impact of preoperative screening for meticillin-resistant Staphylococcus aureus by real-time polymerase chain reaction in patients undergoing cardiac surgery

Cited by 89 publications

References 30 publications

Evaluation of BD Max StaphSR and BD Max MRSA XT Assays Using ESwab-Collected Specimens

Evaluation of BD Max StaphSR and BD Max MRSA XT Assays Using ESwab-Collected Specimens

Laboratory Evaluation of the BD MAX MRSA Assay

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

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