Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/genetics , Macrolides/pharmacology , Mycoplasma Infections/microbiology , Mycoplasma genitalium/drug effects , Mycoplasma genitalium/genetics , RNA, Ribosomal, 23S/genetics , Sexually Transmitted Diseases, Bacterial/microbiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Female , Humans , Macrolides/therapeutic use , Male , Middle Aged , Mutation , Mycoplasma Infections/drug therapy , Mycoplasma Infections/epidemiology , Mycoplasma genitalium/isolation & purification , Netherlands/epidemiology , Prevalence , Sexually Transmitted Diseases, Bacterial/drug therapy , Sexually Transmitted Diseases, Bacterial/epidemiologyABSTRACT
INTRODUCTION: Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs). METHODS: Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT. RESULTS: A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n=5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of 327.84 (IDI) and 252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were 136.04 (IDI) and 121.76 (GeneXpert). CONCLUSIONS: In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of 121.76 to 136.04 per isolation day avoided.
Subject(s)
Intensive Care Units/economics , Mass Screening/economics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/diagnosis , Staphylococcal Infections/economics , Adult , Aged , Cost-Benefit Analysis/methods , Humans , Mass Screening/methods , Middle Aged , Predictive Value of Tests , Prospective Studies , Staphylococcal Infections/prevention & control , Time Factors , Young AdultABSTRACT
The aim of this study was to investigate carriage of Staphylococcus aureus by patients and health care workers (HCW) and to define the genetic relationship of S. aureus strains isolated from burn wounds. At admission, 19/55 (34.5%) patients carried S. aureus in their nose and/or throat. Of this group, 95% subsequently colonized their burn wounds with S. aureus. Molecular analysis showed that in 78% of these cases the burn-wound colonizing strain was identical to the strain carried at admission. Importantly, 23/36 (64%) patients who did not carry S. aureus at admission also developed burn-wound colonization. In this group, three dominant genotypes were identified as colonizing strains of burn wounds. These clones represented also the majority (59%) of S. aureus strains cultured from the nose and/or throat of health care workers and patients. If patients were admitted to one of the Intensive Care rooms burn wounds of non-carriers were not colonized with S. aureus as long as they remained in such isolation. Only patients who carried S. aureus at admission developed burn-wound colonization with that genotype they carried in the nose or throat. Both carriage in patients and health care workers and auto-infection play a crucial role in (cross-) colonization events.
