PURPOSE: When admitted at he hospital, patients at risk for carriership with methicillin-resistant Staphylococcus Aureus (MRSA) are screened with swabs of nose and skin. Despite succesfully decontamination a number of patients become recontaminated. We evaluated whether screening of the throat could detect an additional number of carriers. We also evaluated the possible source of reinfection in COPD patients.
METHODS: We prospectively evaluated high risk patients for MRSA. In the period from January 1 to December 31, 2004, 39 patients with positive MRSA screening were included, accounting for 49 hospital contacts. Screening consisted of swabs of nose, perineum and throat. After decontamination patients were followed and screened at regular intervals. COPD patients were also evaluated with induced sputum and/or bronchial lavage for culturing bronchial specimens.
RESULTS: Of the 39 patients, aged 55 to 89 years, 24 had COPD and only 7 (18%) were residents of a nursing home. Of the 49 contacts, positive swabs were found in perineum in 16 (33%), in nose in 7 (14%), in throat in 10 (20%), in throat and nose in 16 (33%). Of the 24 patients with COPD, 6 (25%) got recontaminated during follow-up of whom 4 (67%) in the throat alone. All those patients also showed MRSA in sputum or bronchial aspiration or BALF. Of the 15 non-COPD patients, only 2 (13%) got recontaminated.
CONCLUSION: The majority of patients with colonisation with MRSA were COPD patients and were not originating from nursing homes.If throat should not have been investigated, 10 of 49 contacts (20%) would not have been detected with the potential risk of false safety.Although not statistically significant, there was a trend that COPD patients got recontaminated more easily than patients without COPD.
CLINICAL IMPLICATIONS: We establish the importance of throat swabs in the screening procedure for MRSA in risk groups. We also hypothese that in COPD patients, recontamination of the throat may originate from colonisation of the lower respiratory tract.
DISCLOSURE: Paul Van Den Brande, None.