Impact of rapid molecular screening for meticillin-resistant <i>Staphylococcus aureus</i> in surgical wards

Keshtgar, M.; Khalili, Ahmad Ali; Coen, Pietro G.; Carder, C; Macrae, Bruce; Jeanes, Annette; Folan, Patricia; Baker, DM; Wren, M. W. D.; Wilson, A.P.R.

doi:10.1002/bjs.6013

Cited by 50 publications

(27 citation statements)

References 28 publications

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“…Since the introduction of rapid molecular tests, other studies have been published investigating the impact of these tests on MRSA transmission and infection rates [15][16][17][18][19][20][21][22]. The majority of these have a retrospective, time intervention study design which does not control for confounding variables.…”

Section: Discussionmentioning

confidence: 99%

Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study

Hardy

Price

Szczepura

et al. 2010

Clinical Microbiology and Infection

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Identification of patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) and subsequent isolation and decolonization is pivotal to the control of cross infection in hospitals. The aim of this study was to establish if early identification of colonized patients using rapid methods alone reduces transmission. A prospective, cluster, two-period cross-over design was used. Seven surgical wards at a large hospital were allocated to two groups, and for the first 8 months four wards used rapid MRSA screening and three wards used a standard culture method. The groups were reversed for the second 8 months. Regardless of the method of detection, all patients were screened for nasal carriage on admission and then every 4 days. MRSA control measures remained constant. Results were analysed using a log linear Poisson regression model. A total of 12 682/13 952 patient ward episodes (PWE) were included in the study. Admission screening identified 453 (3.6%) MRSA-positive patient ward episodes, with a further 268 (2.2%) acquiring MRSA. After adjusting for other variables, rapid screening was shown to statistically reduce MRSA acquisition, with patients being 1.49 times (p 0.007) more likely to acquire MRSA in wards where they were screened using the culture method. Screening of surgical patients using rapid testing resulted in a statistically significant reduction in MRSA acquisition. This result was achieved in a routine surgical service with high bed occupancy and low availability of isolation rooms, making it applicable to the majority of health-care systems worldwide.

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Section: Discussionmentioning

confidence: 99%

Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study

Hardy

Price

Szczepura

et al. 2010

Clinical Microbiology and Infection

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“…We have previously demonstrated the clinical value of sole MRSA rapid PCR testing within our hospital Trust ( Keshtgar et al, 2008 ). A further, recent innovation in screening is the ability to detect both nasal MRSA and MSSA strains from a single in vitro real-time, multiplex PCR system (GeneOhm® MRSA/MSSA combination test, Becton Dickinson, Franklin Lakes, New Jersey, USA).…”

Section: Introductionmentioning

confidence: 99%

Rapid molecular screening for meticillin-sensitive Staphylococcus aureus (MSSA) carriage: an economic evaluation

Scott

Panesar

Grosso

et al. 2011

Journal of Infection Prevention

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Peer reviewed articleim: To establish the cost-effectiveness of screening and treating meticillin-sensitive Staphylococcus aureus (MSSA) carriers, potentially reducing both fi nancial and clinical burdens of managing healthcareacquired infections.Methods: A decision health economic model analysed the impact of a 'screen and treat' strategy for Hospital inpatients from the perspective of the UK National Health Service.Results: Cost savings in excess of £600k and around 840 potential infections could be avoided in a 70,000 patient cohort, at a nasal carriage prevalence of 30 % . For 2000 high infection risk cardiothoracic surgery patients, cost savings could reach £8,636 per annum. The dominance of the 'screen and treat' strategy holds for plausible variations in the model parameter values and simple modelling of secondary transmission.Conclusion: Adopting rapid screening and treating MSSA nasal carriers should be clinically and fi nancially advantageous, compared to current strategies of not screening, even under conservative assumptions for costs and probabilities of managing infections. Abstract A

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“…Despite the lack of convincing evidence (Coia et al, 2006), it is now accepted that a major aspect of controlling the spread of MRSA is the prompt identification of patients at risk of MRSA carriage (Chaix et al, 1999;Cepeda et al, 2005;Malde et al, 2006;Cunningham et al, 2007). Increasing numbers of hospitals in the UK will be expected to perform MRSA screening of all elective hospital admissions and emergency admissions in the near future (Department of Health in England, 2008;Keshtgar et al, 2008). However, there is a possibility that, even if adequate infection control precautions are in place, the delay in obtaining results from screening swabs will allow transmission of MRSA from colonized patients to occur before carriage has been detected.…”

Section: Introductionmentioning

confidence: 99%

Real-time evaluation of an optimized real-time PCR assay versus Brilliance chromogenic MRSA agar for the detection of meticillin-resistant Staphylococcus aureus from clinical specimens

Danial

Noël

Templeton

et al. 2011

Journal of Medical Microbiology

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A total of 1204 meticillin-resistant Staphylococcus aureus (MRSA) screens (3340 individual swabs) were tested to evaluate a staphylococcal cassette chromosome mec (SCCmec) real-time PCR. In total, 148 (12.3 %) of the screens were MRSA-positive, where 146 (12.1 %) were MRSA-positive by the SCCmec real-time PCR assay. In contrast, 128 (10.6 %) screens were MRSA-positive by culture. One hundred and twenty-six (10.5 %) of the screens were positive by both culture and PCR. Twenty of the 1204 screens (1.66 %) were negative by culture but positive by PCR; these samples were sequenced. In 14 of the cases, a homology search confirmed the sequence as SCCmec, indicating that these samples could be considered true positives. Two of the 1204 (0.2 %) screens were positive by culture and negative by PCR. The mean turnaround time (TAT) for PCR-negative swabs was 6 h 12 min and for PCR-positive swabs was 6 h 48 min. In comparison, for culture-negative swabs the mean TAT was 29 h 30 min and for culture-positive swabs was 69 h. The cost per swab for routine culture was £0.41 (J0.48) and that of the realtime PCR assay was £2. 35 (J2.75). This optimized, in-house, inexpensive, real-time PCR test maintained a very high sensitivity and specificity when evaluated under real-time laboratory conditions. The TAT of this real-time PCR assay was substantially lower than that of chromogenic culture. It was also maintained throughout the entire process, which can be taken as an indirect measure of test performance. This study showed that implementation of a molecular test can be achieved with limited resources in a standard microbiology laboratory. INTRODUCTIONMeticillin-resistant Staphylococcus aureus (MRSA) remains a leading cause of healthcare-acquired infection and affects the most vulnerable patients with significant morbidity and mortality (Harbarth et al., 1998;Cosgrove et al., 2003;Salgado et al., 2003;Cooper et al., 2004; Francois et al., 2007). Despite the lack of convincing evidence (Coia et al., 2006), it is now accepted that a major aspect of controlling the spread of MRSA is the prompt identification of patients at risk of MRSA carriage (Chaix et al., 1999;Cepeda et al., 2005;Malde et al., 2006;Cunningham et al., 2007). Increasing numbers of hospitals in the UK will be expected to perform MRSA screening of all elective hospital admissions and emergency admissions in the near future (Department of Health in England, 2008;Keshtgar et al., 2008). However, there is a possibility that, even if adequate infection control precautions are in place, the delay in obtaining results from screening swabs will allow transmission of MRSA from colonized patients to occur before carriage has been detected.Screening using faster methods such as nucleic acid amplification can produce results within 2-4 h directly from clinical samples (Jeyaratnam et al., 2008;Renwick et al., 2008). However, the reality is that various external factors such as sample collection, transport, reception, documentation and reporting significantly increase the real repo...

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Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards

Abstract: Background: This study aimed to establish the feasibility and cost-effectiveness of rapid molecular screening for hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital.

Cited by 50 publications

References 28 publications

Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study

Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study

Rapid molecular screening for meticillin-sensitive Staphylococcus aureus (MSSA) carriage: an economic evaluation

Real-time evaluation of an optimized real-time PCR assay versus Brilliance chromogenic MRSA agar for the detection of meticillin-resistant Staphylococcus aureus from clinical specimens

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