Are Active Microbiological Surveillance and Subsequent Isolation Needed to Prevent the Spread of Methicillin-Resistant Staphylococcus aureus?
Open Access
- 1 February 2005
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 40 (3), 405-409
- https://doi.org/10.1086/427281
Abstract
Background. Infection-control strategies usually combine several interventions. The relative value of individual interventions, however, is rarely determined. We assessed the effect of daily microbiological surveillance alone (e.g., without report of culture results or isolating colonized patients) as an infection-control measure on the spread of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in a medical intensive care unit (MICU). Methods. Colonization of patients with MSSA and MRSA was assessed by cultures of nasal swabs obtained daily and, if a patient was intubated, by cultures of additional endotracheal aspirates. Pulsed-field gel electrophoresis was used to determine relatedness between MSSA or MRSA isolates in surveillance cultures (i.e., cultures of nasal swab specimens obtained daily) and those in clinical cultures (i.e., any other culture performed for clinical purposes). Adherence to infection-control measures by health care workers (HCWs) was determined by observations of HCW-patient interaction. Results. During a 10-week period, surveillance cultures were performed for 158 patients. Fifty-five patients (34.8%) were colonized with MSSA, and 9 (5.7%) were colonized with MRSA. Sixty-two patients were colonized before admission to the hospital (53 had MSSA, and 9 had MRSA). Two patients appeared to have acquired MSSA in the MICU, but, on the basis of genotyping analysis, we determined that this was not the result of cross-acquisition. Conclusion. Surveillance cultures and genotyping of MRSA and MSSA isolates demonstrated the absence of cross-transmission among patients in the MICU, despite ongoing introduction of these pathogens. Reporting culture results and isolating colonized patients, as suggested by some guidelines, would have falsely suggested the success of such infection-control policies.Keywords
This publication has 15 references indexed in Scilit:
- Relative Risk of Physicians and Nurses to Transmit Pathogens in a Medical Intensive Care UnitArchives of Internal Medicine, 2003
- SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains ofStaphylococcus aureusandEnterococcusInfection Control & Hospital Epidemiology, 2003
- Adverse Clinical and Economic Outcomes Attributable to Methicillin Resistance among Patients withStaphylococcus aureusSurgical Site InfectionClinical Infectious Diseases, 2003
- Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureusArchives of Internal Medicine, 2002
- Understanding the Spread of Antibiotic Resistant Pathogens in Hospitals: Mathematical Models as Tools for ControlClinical Infectious Diseases, 2001
- Adverse effects of contact isolationThe Lancet, 1999
- Infection-Control Measures Reduce Transmission of Vancomycin-Resistant Enterococci in an Endemic SettingAnnals of Internal Medicine, 1999
- Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programsProceedings of the National Academy of Sciences, 1999
- Methicillin-Resistant Staphylococcus aureus Control in Hospitals: The Dutch ExperienceInfection Control & Hospital Epidemiology, 1996
- Eradication Of Endemic Methicillin-Resistant Staphylococcus Aureus Infections From A Neonatal Intensive Care UnitThe Journal of Infectious Diseases, 1995