Active surveillance cultures of methicillin-resistant Staphylococcus aureus as a tool to predict methicillin-resistant S. aureus ventilator-associated pneumonia*

Chan, Jeannie D.; Dellit, Timothy H.; Choudhuri, Julie A.; McNamara, Elizabeth; Melius, Elizabeth; Evans, Heather L.; Cuschieri, Joseph; Arbabi, Saman; Lynch, John B.

doi:10.1097/ccm.0b013e318243168e

Cited by 41 publications

(28 citation statements)

References 23 publications

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“…Results similar to ours were recently obtained in a prospective observational study 16 of 388 medical and surgical ICU patients with ventilator-associated pneumonia (VAP). In that study, 37 patients had 5%); most of the patients (3.8% of the total cohort) had pneumonia.…”

Section: Discussionsupporting

confidence: 71%

Nasal Colonization and Lower Respiratory Tract Infections with Methicillin-Resistant Staphylococcus aureus

Tilahun

Faust

McCorstin

et al. 2014

American Journal of Critical Care

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Background Methicillin-resistant Staphylococcus aureus is a cause of lower respiratory tract infections, particularly health care-and ventilator-associated pneumonia. Although many health systems use nasal screening for this microorganism for infection control, correlation between nasal carriage of the organism and development of infections due to it is not clear. Methods Records of patients admitted to medical intensive care between January 1, 2011, and December 31, 2012, were reviewed retrospectively. Patients' data were included if the patients were 18 years or older, satisfied clinical criteria for pneumonia, and had both nasal swabbing and culturing of respiratory specimens within 24 hours of admission. Results A total of 165 patients met the inclusion criteria. Most had either community-acquired or health care-associated pneumonia. Of the 28 patients with a nasal swab positive for methicillinresistant S aureus, 8 (4.8%) also had respiratory tract cultures positive for the microorganism. Among the 165 patients, 2 (1.2%) had negative nasal swabs but positive respiratory cultures. Sensitivity and specificity of nasal colonization with methicillinresistant S aureus for subsequent infection with the pathogen were 80% and 87.1%, respectively; positive and negative predictive values were 28.6% and 98.5%, respectively. Conclusions Nasal screening for methicillin-resistant S aureus may be a valuable tool for de-escalation of empiric therapy targeted to the organism, especially in patients admitted for severe community-acquired or health care-associated pneumonia. The high negative predictive value suggests that patients with a negative nasal swab most likely do not have a lower respiratory tract infection caused by the organism.

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Section: Discussionsupporting

confidence: 71%

Nasal Colonization and Lower Respiratory Tract Infections with Methicillin-Resistant Staphylococcus aureus

Tilahun

Faust

McCorstin

et al. 2014

American Journal of Critical Care

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“…Chan et al [17] reported that active surveillance culture from multiple sites can accurately exclude MRSA as an etiology in most patients with ventilator-associated pneumonia. This observation is consistent with the results presented here; however, differences in the diagnostic value for each anatomic site were not investigated in that study.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, active surveillance for MRSA is recommended in ICU patients [12], though no consensus has been reached regarding which site to use for optimal detection due to limited data [13]–[15]. Moreover, only a few studies have evaluated the predictive value of surveillance culture for subsequent MRSA infections in ICU patients [16], [17], with no study directly comparing the predictive values based upon surveillance culture site.…”

Section: Introductionmentioning

confidence: 99%

Active Surveillance of the Trachea or Throat for MRSA Is More Sensitive than Nasal Surveillance and a Better Predictor of MRSA Infections among Patients in Intensive Care

et al. 2014

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BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of infection in the intensive care unit (ICU). Although surveillance culture for MRSA is recommended for ICU patients, no comparative study investigating the optimal sites and frequency of culture has been performed in this population.MethodsA prospective observational cohort study was performed in an 18-bed emergency intensive care unit (EICU) in a tertiary teaching hospital. A total of 282 patients were included. Samples for MRSA detection were obtained at the time of admission, 48 h after admission, and then weekly thereafter. All subjects were routinely monitored for the development of MRSA infection during their stay in the ICU.ResultsMRSA colonization was detected in 129 (46%) patients over the course of the study. The sensitivity of MRSA surveillance culture was significantly higher in throat or tracheal aspirates (82%; 106/129) than in anterior nares (47%; 61/129) (P<0.001). The sensitivity of MRSA surveillance culture for subsequent MRSA infection and MRSA pneumonia was also higher in the throat/trachea (69 and 93%, respectively) than in the anterior nares (48 and 50%, respectively). The area under the curve for subsequent MRSA infection was higher in trachea/throat (0.675) than in the anterior nares (0.648); however, this difference was not significant (P>0.05). The area under the curve for MRSA pneumonia was significantly higher in trachea/throat (0.791; 95% CI, 0.739-0.837) than anterior nares (0.649; 95% CI, 0.590-0.705) (P = 0.044).ConclusionMRSA colonization was more common in the trachea/throat than in the anterior nares in ICU patients. Cultures from throat or tracheal aspirates were more sensitive and predictive of subsequent MRSA pneumonia than cultures from the anterior nares in this population.

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“…Plumb and Miller for their interest in our article (1). Plumb and Miller for their interest in our article (1).…”

Section: The Authors Replymentioning

confidence: 99%

Polymerase chain reaction–based rapid screening method is the real tool to prevent methicillin-resistant Staphylococcus aureus infections in the intensive care unit

Stano

Camporese

2012

Critical Care Medicine

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Active surveillance cultures of methicillin-resistant Staphylococcus aureus as a tool to predict methicillin-resistant S. aureus ventilator-associated pneumonia*

Cited by 41 publications

References 23 publications

Nasal Colonization and Lower Respiratory Tract Infections with Methicillin-Resistant Staphylococcus aureus

Nasal Colonization and Lower Respiratory Tract Infections with Methicillin-Resistant Staphylococcus aureus

Active Surveillance of the Trachea or Throat for MRSA Is More Sensitive than Nasal Surveillance and a Better Predictor of MRSA Infections among Patients in Intensive Care

Polymerase chain reaction–based rapid screening method is the real tool to prevent methicillin-resistant Staphylococcus aureus infections in the intensive care unit

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