Screening for methicillin-resistant Staphylococcus aureus: A comparative effectiveness review

Glick, Shimon; Samson, David J; Huang, Elbert S.; Vats, Vikrant; Aronson, Naomi; Weber, Stephen G.

doi:10.1016/j.ajic.2013.07.020

Cited by 38 publications

(28 citation statements)

References 55 publications

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“…Seventeen of these studies were reviewed in a recent AHRQ publication [16]. We reviewed these 19 studies and found that in 14, observed benefits of active surveillance reached statistical significance.…”

Section: Reviewmentioning

confidence: 99%

The use of surveillance and preventative measures for methicillin-resistant staphylococcus aureus infections in surgical patients

Kavanagh

Calderon

Saman

et al. 2014

Antimicrob Resist Infect Control

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The Agency for Healthcare Research & Quality (AHRQ) found that Methicillin-resistant Staphylococcus aureus (MRSA) is associated with up to 375,000 infections and 23,000 deaths in the United States. It is a major cause of surgical site infections, with a higher mortality and longer duration of care than Methicillin-sensitive Staphylococcus aureus. A multifactorial bundled approach is needed to control this epidemic, with single interventions unlikely to have a significant impact on attenuating MRSA infection rates.Active surveillance has been studied in a wide range of surgical patients, including surgical intensive care and non-intensive care units; cardiac, vascular, orthopedic, obstetric, head and neck cancer and gastrostomy patients. There is sufficient evidence demonstrating a beneficial effect of surveillance and eradication prior to surgery to recommend its use on an expanded basis.Studies on MRSA surveillance in surgical patients that were published over the last 10 years were reviewed. In at least five of these studies, the MRSA colonization status of patients was reported to be a factor in preoperative antibiotic selection, with the modification of treatment regiments including the switching to vancomycin or teicoplanin in MRSA positive preoperative patients. Several authors also used decolonization protocols on all preoperative patients but used surveillance to determine the duration of the decolonization.Universal decolonization of all patients, regardless of MRSA status has been advocated as an alternative prevention protocol in which surveillance is not utilized. Concern exists regarding antimicrobial stewardship. The daily and universal use of intranasal antibiotics and/or antiseptic washes may encourage the promotion of bacterial resistance and provide a competitive advantage to other more lethal organisms.Decolonization protocols which indiscriminately neutralize all bacteria may not be the best approach. If a patient's microbiome is markedly challenged with antimicrobials, rebuilding it with replacement commensal bacteria may become a future therapy.Preoperative MRSA surveillance allows the selection of appropriate prophylactic antibiotics, the use of extended decolonization protocols in positive patients, and provides needed data for epidemiological studies.

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Section: Reviewmentioning

confidence: 99%

The use of surveillance and preventative measures for methicillin-resistant staphylococcus aureus infections in surgical patients

Kavanagh

Calderon

Saman

et al. 2014

Antimicrob Resist Infect Control

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“…According to multiple cross-sectional surveys, the mean carriage rate across the general population is 37% [3]. Regarding MRSA carriage in the era of CA-MRSA, the overall MRSA carriage rate in the United States has increased from 0.8% in 2001–2002 to 1.5% in 2003–2004, and it is particularly important in the hospital environment because colonized and infected patients represent the most important reservoir of MRSA in healthcare facilities [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Hospital clones of methicillin-resistant Staphylococcus aureus are carried by medical students even before healthcare exposure

Orlin

Rokney

Onn

et al. 2017

Antimicrob Resist Infect Control

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BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students.The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical studentsMethodsProspective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis.ResultsAmong 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19 months (clinical studies), respectively (p = 0.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, p = 0.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected.ConclusionsMSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains.

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“…A recent review of literature published by the Agency for Healthcare Research and Quality in the United States found evidence that universal MRSA carriage screening upon admission programs may reduce the risk of MRSA infections. However, evidence was weak and insufficient to support screening programs [14]. Most of the published studies were experimental or observational studies with before/after design, and the only randomized controlled trial showed no favorable effect of screening programs.…”

Section: Introductionmentioning

confidence: 99%

“…The methodologies of the examined studies were defective since they did not consider changes in the incidence of MRSA infections over time, the use of other measures to reduce incidence of these infections (such as hand washing, decolonization, and availability of private patient rooms among other limitations), making it difficult to know whether the change in incidence of MRSA infections was related to screening or to the previously mentioned confounding variables. In addition, there was inadequate reporting of the results of the screening programs, which may have led to a publication bias since the data reported in literature is just a fraction of the much bigger data of screening programs utilized in hospitals [14].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of MRSA, ESBL and MDR bacterial colonization upon admission to an Egyptian medical ICU

Fouda¹,

Soliman

Elanany

et al. 2016

J Infect Dev Ctries

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Introduction: Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gramnegative bacteria (MDR-GNB) frequently results in life-threatening infections. Universal screening of ICU patients upon admission has been suggested. The aim of the current study was to evaluate the prevalence and pattern of MRSA, ESBL, and MDR-GNB colonization in patients upon admission to an Egyptian medical ICU, along with the related demographic and clinical risk factors. Methodology: Throat, axillary, and groin swabs were obtained from all study participants in addition to rectal swabs from consenting patients. These swabs were screened for MRSA, ESBL, and MDR-GNB. Results: Of the patients included in the study, 33%, 13%, and 63% were colonized with ESBL, MDR-GNB, and MRSA organisms, respectively. Those suffering from a more severe disease with a simplified acute physiology score II (SAPS II) > 29 demonstrated higher levels of MDR-GNB colonization upon admission, while MDR-GNB or ESBL colonization upon admission was associated with higher ICU mortality. Conclusions: Colonization of ICU patients with superbugs upon admission has an impact on outcome and mortality. In this Egyptian example, colonization rates were higher than in other literature reports, demonstrating the need for routine screening and decolonization, if applicable.

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Screening for methicillin-resistant Staphylococcus aureus: A comparative effectiveness review

Cited by 38 publications

References 55 publications

The use of surveillance and preventative measures for methicillin-resistant staphylococcus aureus infections in surgical patients

The use of surveillance and preventative measures for methicillin-resistant staphylococcus aureus infections in surgical patients

Hospital clones of methicillin-resistant Staphylococcus aureus are carried by medical students even before healthcare exposure

Prevalence and risk factors of MRSA, ESBL and MDR bacterial colonization upon admission to an Egyptian medical ICU

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