Makoto Jones1, Christopher Nielson2, Kalpana Gupta3, Karim Khader4, Martin Evans5. 1. Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT; Department of Internal Medicine, University of Utah, Salt Lake City, UT. 2. Veterans Affairs Reno Medical Center, Reno, NV; Department of Internal Medicine, University of Nevada, Reno, NV. 3. Department of Veterans Affairs, Boston Veterans Affairs Health Care System, National Center for Occupational Health and Infection Control, Office of Public Health, Boston, MA; Department of Internal Medicine, Boston University, Boston, MA. 4. Department of Internal Medicine, University of Utah, Salt Lake City, UT. 5. Department of Veterans Affairs, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Veterans Health Administration, Washington, DC; Lexington Veterans Affairs Medical Center, Lexington, KY; Department of Internal Medicine, University of Kentucky, Lexington, KY. Electronic address: martin.evans@va.gov.
Abstract
BACKGROUND: Surveillance at hospital admission for multidrug-resistant (MDR) gram-negative bacteria (GNB) is not often performed, potentially leaving patients carrying these organisms unrecognized and not placed in transmission precautions until they develop infection. Veterans Affairs (VA) facilities screen all admissions for methicillin-resistant Staphylococcus aureus (MRSA) and place positive patients in contact precautions. We assessed how often patients with MDR GNB in clinical cultures obtained within 30 days following admission would have been in contact precautions because of a positive MRSA admission screen. METHODS: MRSA screening and MDR GNB culture results were extracted from a database of patients admitted to all VA acute care medical facilities from January 2009-December 2012. RESULTS: Of patients with MDR GNB-positive cultures within 30 days following admission, up to 44.3% (dependent on bacterial species) would have been in contact precautions because of a clinical positive admission MRSA nasal screen. Admissions with a positive MRSA screen had odds for MDR GNB in a culture 2.5 times greater than those with a negative screen (95% confidence interval [CI], 2.4-2.6). Odds ratios were 2.4 (95% CI, 2.3-2.5) for MDR Enterobacteriaceae, 2.7 (95% CI, 2.5-2.9) for MDR Pseudomonas aeruginosa, and 4.3 (95% CI, 3.8-4.8) for MDR Acinetobacter spp. CONCLUSIONS: Patients may be serendipitously placed in contact precautions for MDR GNB when isolated for a positive admission MRSA screen. Published by Elsevier Inc.
BACKGROUND: Surveillance at hospital admission for multidrug-resistant (MDR) gram-negative bacteria (GNB) is not often performed, potentially leaving patients carrying these organisms unrecognized and not placed in transmission precautions until they develop infection. Veterans Affairs (VA) facilities screen all admissions for methicillin-resistant Staphylococcus aureus (MRSA) and place positive patients in contact precautions. We assessed how often patients with MDR GNB in clinical cultures obtained within 30 days following admission would have been in contact precautions because of a positive MRSA admission screen. METHODS: MRSA screening and MDR GNB culture results were extracted from a database of patients admitted to all VA acute care medical facilities from January 2009-December 2012. RESULTS: Of patients with MDR GNB-positive cultures within 30 days following admission, up to 44.3% (dependent on bacterial species) would have been in contact precautions because of a clinical positive admission MRSA nasal screen. Admissions with a positive MRSA screen had odds for MDR GNB in a culture 2.5 times greater than those with a negative screen (95% confidence interval [CI], 2.4-2.6). Odds ratios were 2.4 (95% CI, 2.3-2.5) for MDR Enterobacteriaceae, 2.7 (95% CI, 2.5-2.9) for MDR Pseudomonas aeruginosa, and 4.3 (95% CI, 3.8-4.8) for MDR Acinetobacter spp. CONCLUSIONS:Patients may be serendipitously placed in contact precautions for MDR GNB when isolated for a positive admission MRSA screen. Published by Elsevier Inc.
Authors: Alun Thomas; Karim Khader; Andrew Redd; Molly Leecaster; Yue Zhang; Makoto Jones; Tom Greene; Matthew Samore Journal: Math Med Biol Date: 2018-03-16 Impact factor: 1.854
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Authors: Karim Khader; Alun Thomas; Vanessa Stevens; Lindsay Visnovsky; McKenna Nevers; Damon Toth; Lindsay T Keegan; Makoto Jones; Michael Rubin; Matthew H Samore Journal: JAMA Netw Open Date: 2021-03-01