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Universal Surveillance for Methicillin-Resistant Staphylococcus aureus in 3 Affiliated Hospitals
- Ari Robicsek, MD;
- Jennifer L. Beaumont, MS;
- Suzanne M. Paule, BS;
- Donna M. Hacek, BS;
- Richard B. Thomson, Jr., PhD;
- Karen L. Kaul, MD, PhD;
- Peggy King, RN, MBA; and
- Lance R. Peterson, MD
- From Evanston Northwestern Healthcare and Northwestern University Feinberg School of Medicine, Evanston, Illinois.
Abstract
Background: The effect of large-scale expanded surveillance for methicillin-resistant Staphylococcus aureus (MRSA) on health care–associated MRSA disease is not known.
Objective: To examine the effect of 2 expanded surveillance interventions on MRSA disease.
Design: Observational study comparing rates of MRSA clinical disease during and after hospital admission in 3 consecutive periods: baseline (12 months), MRSA surveillance for all admissions to the intensive care unit (ICU) (12 months), and universal MRSA surveillance for all hospital admissions (21 months).
Setting: A 3-hospital, 850-bed organization with approximately 40 000 annual admissions.
Intervention: Polymerase chain reaction–based nasal surveillance for MRSA followed by topical decolonization therapy and contact isolation of patients who tested positive for MRSA.
Measurements: Poisson and segmented regression models were used to compare prevalence density of hospital-associated clinical MRSA disease (bloodstream, respiratory, urinary tract, and surgical site) in each period. Rates of bloodstream disease with methicillin-susceptible S. aureus were used as a control.
Results: The prevalence density of aggregate hospital-associated MRSA disease (all body sites) per 10 000 patient-days at baseline, during ICU surveillance, and during universal surveillance was 8.9 (95% CI, 7.6 to 10.4), 7.4 (CI, 6.1 to 9.0; P = 0.15 compared with baseline), and 3.9 (CI, 3.2 to 4.7; P < 0.001 compared with baseline and ICU surveillance), respectively. During universal surveillance, the prevalence density of MRSA infection at each body site had a statistically significant decrease compared with baseline. The methicillin-susceptible S. aureus bacteremia rate did not statistically significantly change during the 3 periods. In a segmented regression model, the aggregate hospital-associated MRSA disease prevalence density changed by −36.2% (CI, −65.4% to 9.8%; P = 0.17) from baseline to ICU surveillance and by −69.6% (CI, −89.2% to −19.6%]; P = 0.03) from baseline to universal surveillance. During universal surveillance, the MRSA disease rate decreased during hospitalization and in the 30 days after discharge; no further reduction occurred thereafter. Surveillance with clinical cultures would have identified 17.8% of actual MRSA patient-days, and ICU-based surveillance with polymerase chain reaction would have identified 33.3%.
Limitation: The findings rely on observational data.
Conclusion: The introduction of universal admission surveillance for MRSA was associated with a large reduction in MRSA disease during admission and 30 days after discharge.
Article and Author Information
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Acknowledgment: The authors thank Judson Vosburg and the Evanston Northwestern Healthcare administration for their support, Toni-Marie Gonzalzles for chart review, and Ilana Segal and Michael Klompas for thoughtful comments on the manuscript.
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Potential Financial Conflicts of Interest:Consultancies: R.B. Thomson (GlaxoSmithKline), K.L. Kaul (Roche). Honoraria: A. Robicsek (Becton Dickinson), S.M. Paule (Becton Dickinson), R.B. Thomson (Becton Dickinson), K.L. Kaul (Roche, Becton Dickinson), L.R. Peterson (Becton Dickinson). Grants received: K.L. Kaul (Roche), L.R. Peterson (Becton Dickinson, Cepheid, 3M, Roche, Nanosphere). Grants pending: A. Robicsek (Becton Dickinson), L.R. Peterson (Becton Dickinson, Cepheid, 3M, Roche).
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Reproducible Research Statement:Study protocol: Available from Dr. Peterson (e-mail, lancer{at}northwestern.edu). Statistical code: Available from Dr. Robicsek (e-mail, ari.robicsek{at}gmail.com). Data set: Available from Dr. Robicsek (e-mail, ari.robicsek{at}gmail.com).
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Requests for Single Reprints: Lance R. Peterson, MD, Department of Pathology and Laboratory Medicine, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201; e-mail, lancer{at}northwestern.edu.
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Current Author Addresses: Dr. Robicsek: Department of Medicine, Division of Infectious Diseases, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201.
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Ms. Beaumont: Center on Outcomes, Research, and Education, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201.
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Ms. Paule and Ms. Hacek: Department of Pathology and Laboratory Medicine, Division of Microbiology, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201.
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Drs. Thompson, Kaul, and Peterson: Department of Pathology and Laboratory Medicine, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201.
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Ms. King: Department of Risk Management, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201.
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Author Contributions: Conception and design: A. Robicsek, S.M. Paule, D.M. Hacek, R.B. Thomson, K.L. Kaul, P. King, L.R. Peterson.
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Analysis and interpretation of the data: A. Robicsek, J.L. Beaumont, S.M. Paule, D.M. Hacek, R.B. Thomson, K.L. Kaul, P. King, L.R. Peterson.
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Drafting of the article: A. Robicsek, J.L. Beaumont, L.R. Peterson.
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Critical revision of the article for important intellectual content: J.L. Beaumont, S.M. Paule, D.M. Hacek, R.B. Thomson, P. King, L.R. Peterson.
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Final approval of the article: J.L. Beaumont, S.M. Paule, D.M. Hacek, R.B. Thomson, K.L. Kaul, P. King, L.R. Peterson.
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Statistical expertise: J.L. Beaumont.
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Obtaining of funding: P. King.
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Administrative, technical, or logistic support: S.M. Paule, D.M. Hacek, R.B. Thomson, K.L. Kaul, L.R. Peterson.
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Collection and assembly of data: S.M. Paule, K.L. Kaul, L.R. Peterson.
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