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The Effect of Rapid Screening for Methicillin-Resistant Staphylococcus aureus (MRSA) on the Identification and Earlier Isolation of MRSA-Positive Patients

Published online by Cambridge University Press:  02 January 2015

Eilish Creamer ,
Anthony Dolan ,
Orla Sherlock ,
Toney Thomas ,
John Walsh ,
Joan Moore ,
Edmond Smyth ,
Eoghan O'Neill ,
Anna Shore  and
Derek Sullivan
...Show all authors
Eilish Creamer*
Affiliation:
Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
Anthony Dolan
Affiliation:
Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
Orla Sherlock
Affiliation:
Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
Toney Thomas
Affiliation:
Infection Prevention and Control Department, Dublin, Ireland
John Walsh
Affiliation:
Infection Prevention and Control Department, Dublin, Ireland
Joan Moore
Affiliation:
Department of Microbiology, Beaumont Hospital, Dublin, Ireland
Edmond Smyth
Affiliation:
Department of Microbiology, Beaumont Hospital, Dublin, Ireland
Eoghan O'Neill
Affiliation:
Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
Anna Shore
Affiliation:
Microbiology Research Unit, Division of Oral Biosciences, School of Dental Science and Dublin Dental Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
Derek Sullivan
Affiliation:
Microbiology Research Unit, Division of Oral Biosciences, School of Dental Science and Dublin Dental Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
Angela S. Rossney
Affiliation:
National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland
Robert Cunney
Affiliation:
Health Protection Surveillance Centre, Dublin, Ireland
David Coleman
Affiliation:
Microbiology Research Unit, Division of Oral Biosciences, School of Dental Science and Dublin Dental Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
Hilary Humphreys
Affiliation:
Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Microbiology, Beaumont Hospital, Dublin, Ireland
*
Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, PO Box 9063, Beaumont Road, Dublin 9, Ireland (eilishcreamer@rcsi.ie)
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Abstract

Objectives.

(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.

Design.

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.

Results.

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.

Conclusions.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 374 - 381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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