The effect of rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) on the identification and earlier isolation of MRSA-positive patients.
Authors
Creamer, EilishDolan, Anthony
Sherlock, Orla
Thomas, Toney
Walsh, John
Moore, Joan
Smyth, Edmond
O'Neill, Eoghan
Shore, Anna
Sullivan, Derek
Rossney, Angela S
Cunney, Robert
Coleman, David
Humphreys, Hilary
Affiliation
Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons, Ireland. eilishcreamer@rcsi.ieIssue Date
2010-04MeSH
AgarBacterial Typing Techniques
Bacteriological Techniques
Chromogenic Compounds
Culture Media
Guideline Adherence
Humans
Mass Screening
Methicillin-Resistant Staphylococcus aureus
Microbial Sensitivity Tests
Polymerase Chain Reaction
Predictive Value of Tests
Risk Factors
Sensitivity and Specificity
Staphylococcal Infections
Time Factors
Metadata
Show full item recordCitation
The effect of rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) on the identification and earlier isolation of MRSA-positive patients. 2010, 31 (4):374-81 Infect Control Hosp EpidemiolJournal
Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of AmericaDOI
10.1086/651093PubMed ID
20184438Abstract
(1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results.Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued.
Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P < .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389; P < .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140; P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours.
Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.
Item Type
ArticleLanguage
enISSN
1559-6834ae974a485f413a2113503eed53cd6c53
10.1086/651093
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