PURPOSE: The effect of screening patients for nasal colonization of Methicillin-Resistant Staphylococcus Aureus (MRSA) admitted to the adult medical intensive care unit (MICU) on MRSA infections and the usage of vancomycin.
METHODS: All admissions to the adult MICU, from September 2006 to March 2007, were prospectively screened for nasal colonization with MRSA using qualitative assay based on amplification of MRSA DNA by real-time polymerase chain reaction (PCR) followed by fluorogenic target-specific hybridization probes for detection of the amplified DNA. Positive patients were placed on contact isolation and decolonized with intranasal topical mupirocin. Patients were retested after completing mupirocin therapy, and contact isolation was discontinued after successful decolonization. The comparison of MRSA infections during the pre-intervention period and study period was conducted using the Pearson chi-square test. A P<0.05 was considered statistically significant.
RESULTS: Of the 596 patients admitted to the MICU, 534 (89.6%) were screened for nasal colonization with MRSA. 110 out of 534 patients (20.6%) were positive for nasal colonization with MRSA. 10 out of 534 patients (1.9%) were infected with MRSA during the 7-month study period compared to 30 of 620 patients (4.8%) during the pre-intervention period of January 2006 to August 2006 (P ≤;0.01). One patient had hospital-aquired MRSA (HA-MRSA) infection during the study period compared to 13 patients in the pre-intervention period. Vancomycin consumption for the treatment of MRSA infections decreased from 20.6 defined daily dose/1000 patient-days (DDD/1000pd) in the pre-intervention period to 4.8 DDD/1000pd during the study period.
CONCLUSION: Active MRSA screening for nasal colonization at the time of admission to the adult MICU using PCR-based technology appears to be an effective strategy for achieving a decrease in MRSA infections and vancomycin utilization.
CLINICAL IMPLICATIONS: A decrease in MRSA infection as well as vancomycin utilization in the adult MICU can have a profound effect on the continuing prevelent problem of MRSA infection in the adult MICU.
DISCLOSURE: Christina Migliore, No Financial Disclosure Information; No Product/Research Disclosure Information