Risk factors for positive admission surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in a neurocritical care unit*

Abstract

Colonization with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in neurocritical care patients can be predicted with a high predictive accuracy using decision trees that include four to six readily attainable risk factors. In our setting, in the absence of these risk factors and in patients admitted from home for neurosurgical procedures, routine admission surveillance cultures to the intensive care unit may not be cost-effective.

Infecção ou colonização por micro-organismos resistentes: identificação de preditores

“…(15) The prevalence of resistant microorganisms that frequently cause nosocomial infections is modified according to the study site, with rates between 58 and 71% of PRC and between 43 and 59% of MRSA. (11,15) In this study however, prevalence of these agents was lower: 24.7% for PRC and 25.9% for MRSA.…”

“…The purpose of this collection is the early identification of MDRO colonized or infected patients and the immediate deploy of infection control strategies, reducing cross-contamination and the risk of developing subsequent infections. (11) However, this practice is only strongly recommended in outbreak situations, in endemic cases that are not controllable with protocol measures or in risk populations because surveillance cultures consume material and human resources and have high costs. (2) Moreover, the influx of MDRO colonized patients does not change and there is a delay in obtaining culture test results, favoring the spread of these agents.…”

“…(11) Studies show it is useful to perform epidemiological surveillance cultures to know the real extent of the resistance problem in healthcare facilities. (12) Surveillance cultures must be performed in order to diagnose colonized or infected patients, who are a reservoir for dissemination of these microorganisms.…”

Evaluation of GeneXpert vanA/vanB assay for the detection of vancomycin-resistant enterococci in patients newly admitted to intensive care units

“…The prevalence of VRE carriage on ICU admission has been reported between 1.4% and 25% in different studies (12,(15)(16)(17)(18)(19)(20). The number of positive samples by GeneXpert vanA/vanB method was 33 (7.3%) among the 454 rectal specimens sent in our study.…”

Colonización y/o infección por Staphylococcus aureus resistente a meticilina y otros multirresistentes al ingreso en la Unidad de Cuidados Intensivos: modelo predictivo

“…Otros autores como Torre-Cisneros et al143 y Robicsek et al124 calculan la probabilidad de estar colonizado o infectado por SARM según esta probabilidad esté definida Finalmente, para conseguir mayor calidad metodológica, en algunos trabajos se somete al modelo predictivo generado a una validación, comprobando la precisión del mismo en una población distinta de la que se usó para generar el modelo114;125;141;144 .A pesar de que este esquema descrito(univariablemultivariablemodelovalidación) es el más utilizado a la hora de crear los modelos predictivos, no es el único. Otros autores han utilizado métodos alternativos como la técnica de "árbol de clasificación y regresión" o técnica CART en el caso de Minhas et al145 , los términos lógicos de BOOLE en la combinación de factores de riesgo con un test microbiológico en el caso de Jinno et al144 o el análisis factorial en utilizado por Haley et al146 . Incluso se han intentado crear redes neuronales artificiales como la desarrollada por Hsu et al147 para predecir la probabilidad de estar colonizado al ingreso hospitalario.…”