INTRODUCTION: All patients admitted to Danish hospitals are screened for methicillin-resistant Staphylococcus aureus (MRSA) by a questionnaire consisting of 19 questions issued by the Danish Health and Medicines Authority (DHMA). This study aimed to evaluate which of the questions were most useful. Furthermore, we assessed if other questions were more adequate and if a simplified screening model would perform equal to or better than the one presently used. METHODS: Swabs were obtained for MRSA culture from patients who were more than ten years old and who had been admitted to an emergency department (ED). All DHMA questions together with a range of additional questions were answered. RESULTS: Among the 1,220 patients who participated, 0.9% were MRSA carriers. Only three DHMA questions were associated with a significant risk of MRSA carriage. The additional questions associated with MRSA were "stayed with a non-Danish family within the past three years" and "daily contact with children at a nursery or kindergarten". A new model with only five questions increased the sensitivity insignificantly from 18-55% to 73% in the revised model, whereas no changes were seen for specificity, predictive values or likelihood ratios. CONCLUSIONS: The DHMA's targeted screening for MRSA detection contained only few questions with significant association to MRSA carrier stage. A model based on only five questions seems to insignificantly improve the MRSA screening in this population. In order to develop a more simple and effective screening model, we recommend that our findings be tested in another ED patient population. FUNDING: Southern Jutland Hospital funded this study. TRIAL REGISTRATION: not relevant.
INTRODUCTION: All patients admitted to Danish hospitals are screened for methicillin-resistant Staphylococcus aureus (MRSA) by a questionnaire consisting of 19 questions issued by the Danish Health and Medicines Authority (DHMA). This study aimed to evaluate which of the questions were most useful. Furthermore, we assessed if other questions were more adequate and if a simplified screening model would perform equal to or better than the one presently used. METHODS: Swabs were obtained for MRSA culture from patients who were more than ten years old and who had been admitted to an emergency department (ED). All DHMA questions together with a range of additional questions were answered. RESULTS: Among the 1,220 patients who participated, 0.9% were MRSA carriers. Only three DHMA questions were associated with a significant risk of MRSA carriage. The additional questions associated with MRSA were "stayed with a non-Danish family within the past three years" and "daily contact with children at a nursery or kindergarten". A new model with only five questions increased the sensitivity insignificantly from 18-55% to 73% in the revised model, whereas no changes were seen for specificity, predictive values or likelihood ratios. CONCLUSIONS: The DHMA's targeted screening for MRSA detection contained only few questions with significant association to MRSA carrier stage. A model based on only five questions seems to insignificantly improve the MRSA screening in this population. In order to develop a more simple and effective screening model, we recommend that our findings be tested in another ED patient population. FUNDING: Southern Jutland Hospital funded this study. TRIAL REGISTRATION: not relevant.
Authors: Helene Skjøt-Arkil; Christian Backer Mogensen; Annmarie Touborg Lassen; Isik S Johansen; Ming Chen; Poul Petersen; Karen V Andersen; Svend Ellermann-Eriksen; Jørn M Møller; Marc Ludwig; David Fuglsang-Damgaard; Finn Erland Nielsen; Dan B Petersen; Ulrich S Jensen; Flemming S Rosenvinge Journal: BMJ Open Date: 2019-06-27 Impact factor: 2.692