Discontinuation of Contact Precautions for Methicillin-Resistant Staphylococcus aureus: A Randomized Controlled Trial Comparing Passive and Active Screening With Culture and Polymerase Chain Reaction

February 19, 2017 at 11:35 am

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.176-184

Erica S. Shenoy, JiYeon Kim, Eric S. Rosenberg, Jessica A. Cotter, Hang Lee, Rochelle P. Walensky, and David C. Hooper

1Harvard Medical School

2Division of Infectious Diseases, Department of Medicine

3Biostatistics Center

4Center for AIDS Research

5Department of Pathology

6Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts

Background

There have been no randomized controlled trials comparing active and passive screening for documenting clearance of colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the efficacy of active and passive screening using both culture and commercial polymerase chain reaction (PCR) for documentation of MRSA clearance and discontinuation of MRSA contact precautions (CPs).

Methods

Inpatients with a history of MRSA infection or colonization enrolled between December 2010 and September 2011 were randomized to either passive (nonintervention arm; n = 202; observation with local standard of care) or active screening (intervention arm; n = 405; study staff screened using culture and commercial PCR). The primary outcome was discontinuation of CPs by trial arm based on 3 negative cultures. In the intervention arm, sensitivity, specificity, and positive and negative predictive values of the first PCR were compared to cultures.

Results

CPs were discontinued significantly more often (rate ratio [RR], 4.1; 95% confidence interval [CI], 2.3%–7.1%) in the intervention arm, including in an intent-to-screen analysis (RR, 2.6; 95% CI, 1.5%–4.7%). The first PCR, compared to 3 cultures, detected MRSA with a sensitivity of 93.9% (95% CI, 85.4%–97.6%), a specificity of 92.0% (95% CI, 85.9%–95.6%), a positive predictive value of 86.1% (95% CI, 75.9%–93.1%), and a negative predictive value of 96.6% (95% CI, 91.6%–99.1%).

Conclusions

Compared to passive screening using culture methods, active screening resulted in discontinuation of MRSA CPs at a significantly higher frequency. Active screening with a single PCR would significantly increase the completion of the screening process. In this randomized controlled trial, active screening was superior to passive screening for discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus, and a single negative nasal swab processed by polymerase chain reaction had a high negative predictive value compared to 3 nasal cultures. Clinical Trials Registration. NCT01234831.

PDF

http://cid.oxfordjournals.org/content/57/2/176.full.pdf

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Entry filed under: Bacterias, Biología Molecular, Desinfection and Sterilization, Epidemiología, Health Care-Associated Infections, Infecciones nosocomiales, Metodos diagnosticos, Resistencia bacteriana, Update.

REVISION – Proteómica en enfermedades infecciosas Effect of Adequate Single-Drug vs Combination Antimicrobial Therapy on Mortality in Pseudomonas aeruginosa Bloodstream Infections: A Post Hoc Analysis of a Prospective Cohort


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