Subject(s)
Adenocarcinoma of Lung/therapy , Analgesics, Opioid/adverse effects , Esophageal Achalasia/diagnosis , Liver Neoplasms/therapy , Lung Neoplasms/pathology , Adenocarcinoma of Lung/diagnosis , Adenocarcinoma of Lung/secondary , Aged , Analgesics, Opioid/administration & dosage , Biopsy , Dilatation , Endoscopy, Digestive System , Esophageal Achalasia/chemically induced , Esophageal Achalasia/therapy , Esophagogastric Junction/diagnostic imaging , Esophagogastric Junction/drug effects , Esophagogastric Junction/physiopathology , Female , Humans , Liver/diagnostic imaging , Liver/pathology , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Lymphatic Metastasis , Manometry , Morphinans/administration & dosage , Narcotic Antagonists/administration & dosage , Palliative Care/methods , Polyethylene Glycols/administration & dosage , Treatment OutcomeABSTRACT
BACKGROUND: The screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA) is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed. METHODOLOGY/PRINCIPAL FINDINGS: During a four-week period, all 24 acute care hospitals of the State of Saarland participated in admission prevalence screening. Overall, 436/20,027 screened patients revealed MRSA carrier status (prevalence, 2.2/100 patients) with geriatrics and intensive care departments associated with highest prevalence (7.6/100 and 6.3/100, respectively). Risk factor analysis among 17,975 admission patients yielded MRSA history (OR, 4.3; CI95 2.7-6.8), a skin condition (OR, 3.2; CI95 2.1-5.0), and/or an indwelling catheter (OR, 2.2; CI95 1.4-3.5) among the leading risks. Hierarchical risk factor ascertainment of the six risk factors associated with highest odd's ratios would require 31% of patients to be laboratory screened to allow for detection of 67% of all MRSA positive admission patients in the State. CONCLUSIONS/SIGNIFICANCE: State-wide admission prevalence screening in conjunction with risk factor ascertainment yields important information on the distribution of the MRSA burden for hospitals, and allows for data-based decisions on local or institutional MRSA screening policies considering risk factor prevalence and expected MRSA identification rates.
