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1 February 2007

Volume 195, Number 3
The Journal of Infectious Diseases 2007;195:330–338
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19503-0005$15.00
DOI: 10.1086/510622
MAJOR ARTICLE

Improving Methicillin‐Resistant Staphylococcus aureus Surveillance and Reporting in Intensive Care Units

Susan S. Huang,1,2

Sheryl L. Rifas‐Shiman,2

David K. Warren,3

Victoria J. Fraser,3

Michael W. Climo,4

Edward S. Wong,4

Sara E. Cosgrove,5

Trish M. Perl,5

Jean M. Pottinger,6

Loreen A. Herwaldt,6

John A. Jernigan,7

Jerome L. Tokars,7,8

Daniel J. Diekema,6

Virginia L. Hinrichsen,2

Deborah S. Yokoe,1

Richard Platt,1,2 and the

Centers for Disease Control and Prevention Epicenters Program

1Brigham and Women’s Hospital, Channing Laboratory and Infection Control Department, and 2Department of Ambulatory Care and Prevention, Harvard Medical School, and Harvard Pilgrim Health Care, Boston, Massachusetts; 3Washington University School of Medicine, Division of Infectious Diseases, St. Louis, Missouri; 4Hunter Holmes McGuire Veterans Affairs Medical Center, Division of Infectious Diseases, Richmond, Virginia; 5The Johns Hopkins Medical Institutions, Department of Hospital Epidemiology and Infection Control, Baltimore, Maryland; 6University of Iowa Hospitals and Clinics, Program of Hospital Epidemiology, Iowa City; 7Division of Healthcare Quality Promotion and 8Biosense, National Center for Public Health Informatics, Centers for Disease Control and Prevention, Atlanta, Georgia

Background.Routine culturing of patients in intensive care units (ICUs) for methicillin‐resistant Staphylococcus aureus (MRSA) identifies unrecognized carriers and facilitates timely isolation. However, the benefit of surveillance in detecting prevalent and incident carriers likely varies among ICUs. In addition, many assessments underestimate the incidence of acquisition by including prevalent carriers in the at‐risk population.

Methods.We performed a retrospective cohort study using accurate at‐risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting otherwise unrecognized MRSA in 12 ICUs in 5 states.

Results.We assessed 142 ICU‐months. Among the 12 ICUs, the admission prevalence of imported MRSA was 5%–21%, with admission surveillance providing 30%–135% increases in rates of detection. The monthly hospital‐associated incidence was 2%–6%, with weekly surveillance providing 7%–157% increases in detection. The common practice of reporting incidence using the total number of patients or total patient‐days underestimated incidence by one‐third. Surgical ICUs had lower MRSA importation but higher MRSA incidence. Overall, routine surveillance prevented the misclassification of 17% (unit range, 11%–29%) of “incident” carriers, compared with clinical cultures, and increased precaution days by 18% (unit range, 11%–91%).

Conclusions.Routine surveillance significantly increases the detection of MRSA, but this benefit is not uniform across ICUs, even with high compliance and the use of correct denominators.

Received 25 April 2006; accepted 1 August 2006; electronically published 27 December 2006.

  • (See the editorial commentary by Talbot, on pages 314–7, and the article by Huang et al., on pages 339–46.)

Reprints or correspondence: Dr. Susan S. Huang, Brigham and Women’s Hospital, Channing Laboratory, 181 Longwood Ave., Boston, MA 02115 ().

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  • Potential conflicts of interest: V.J.F. serves as a consultant for Steris Corporation and Verimetrix and is on the speakers bureau for Pfizer and Merck. D.K.W. is on the speakers bureau for Pfizer, has served as a consultant for 3M Healthcare, and has received research funding from Astellas Pharmaceuticals and GeneOhm Sciences, Inc. M.W.C. serves as a consultant for Biosynexus and has 2 patents related to the use of lysostaphin. S.E.C. serves as a consultant for Cubist Pharmaceuticals, has received grant support from Merck, and has served on an advisory board for Ortho‐McNeil. L.A.H. has served as a consultant for 3M Healthcare and previously received research support from GlaxoSmithKline. T.M.P. serves on the advisory board for 3M Healthcare, Cubist Pharmaceuticals, and Replidyne and has been on the speakers bureau for Pfizer, Pharmacia, and Wyeth. D.J.D. receives research support from Merck, Pfizer, Schering Plough, and Astellas. R.P. receives research support from GlaxoSmithKline, Pfizer, Sanofi‐Aventis, and TAP Pharmaceuticals. Future funding from Sage, Inc., is expected for M.W.C., T.M.P., D.K.W., E.S.W., and D.S.Y. All other authors report no potential conflicts.

  • Presented in part: 15th Annual Meeting of the Society of Healthcare Epidemiology of America, Los Angeles, 9–12 April 2005 (abstract 19).

    Financial support: Centers for Disease Control and Prevention Epicenters Program; National Institutes of Health (grant K23AI64161‐01).

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