Document Detail

Nasal swabs collected routinely to screen for colonization by methicillin-resistant Staphylococcus aureus in intensive care units are a sensitive screening test for the organism in clinical cultures.
MedLine Citation:
PMID:  20969468     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Many hospitals screen patients for methicillin-resistant Staphylococcus aureus (MRSA) on admission to the intensive care unit (ICU). We hypothesized that this screening information could be used to assist with empiric antibiotic decisions.
METHODS: The medical records of patients admitted to a university-affiliated community hospital as well as a tertiary-care university hospital were reviewed. Patients admitted to the ICU were screened for MRSA colonization with a nasal swab that was analyzed with either chromogenic medium (hospital 1) or polymerase chain reaction (PCR) (hospital 2). The results of the nasal swab were compared with clinical culture results.
RESULTS: There were 141 patients, and 167 cultures were obtained. The majority of the cultures (70%) were performed on sputum specimens in an effort to diagnose pneumonia. The remaining cultures were performed on blood (10.1%), incisions (21.5%), and urine (3.4%). The overall sensitivity of nasal swab results was 69.5%. However, the sensitivity was significantly higher for nasal swab screening performed within six days of clinical cultures compared with screening performed seven days or more before cultures were obtained. (79% vs. 46%; p < 0.0001). Sensitivity also differed significantly depending on the surveillance method, being significantly higher among patients screened with PCR within six days of developing an infection than in patients screened with chromogenic medium (88% vs. 65.5%; p = 0.006).
CONCLUSION: Screening with PCR analysis of nasal swab specimens is a highly sensitive test for MRSA in clinical cultures. Clinicians may be able to use the swab results to tailor more appropriate empiric antimicrobial regimens. The results with chromogenic medium screening are markedly poorer, which suggests that clinicians should view them with caution.
Matthew C Byrnes; Titi Adegboyega; Andrew Riggle; Jeffrey Chipman; Greg Beilman; Patty Reicks; Kim Boeser; Eric Irwin
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Surgical infections     Volume:  11     ISSN:  1557-8674     ISO Abbreviation:  Surg Infect (Larchmt)     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-10-25     Completed Date:  2011-01-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815642     Medline TA:  Surg Infect (Larchmt)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  511-5     Citation Subset:  IM    
Department of Trauma , North Memorial Medical Center, Robbinsdale, MN, USA.
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MeSH Terms
Bacteriological Techniques / methods*
Carrier State / diagnosis*,  microbiology
Cross Infection / diagnosis*,  microbiology
Culture Media / chemistry
Intensive Care Units
Mass Screening / methods*
Methicillin-Resistant Staphylococcus aureus / isolation & purification*
Middle Aged
Nasal Mucosa / microbiology*
Polymerase Chain Reaction / methods
Sensitivity and Specificity
Staphylococcal Infections / diagnosis*,  microbiology
Time Factors
Reg. No./Substance:
0/Culture Media
Comment In:
Surg Infect (Larchmt). 2010 Dec;11(6):497-9   [PMID:  20969467 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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