TY - JOUR
T1 - Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments
T2 - evaluation of national screening guidelines
AU - Skjøt-Arkil, H
AU - Mogensen, C B
AU - Lassen, A T
AU - Johansen, I S
AU - Chen, M
AU - Petersen, P
AU - Andersen, K V
AU - Ellermann-Eriksen, S
AU - Møller, J M
AU - Ludwig, M
AU - Fuglsang-Damgaard, D
AU - Nielsen, F E
AU - Petersen, D B
AU - Jensen, U S
AU - Rosenvinge, F S
N1 - Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Multi-resistant bacteria (MRB) are an emerging problem. Early identification of patients colonized with MRB is mandatory to avoid in-hospital transmission and to target antibiotic treatment. Since most patients pass through specialized emergency departments (EDs), these departments are crucial in early identification. The Danish National Board of Health (DNBH) has developed exposure-based targeted screening tools to identify and isolate carriers of meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE).AIM: To assess the national screening tools for detection of MRSA and CPE carriage in a cohort of acute patients. The objectives were to investigate: (i) if the colonized patients were detected; and (ii) if the colonized patients were isolated.METHODS: This was a multi-centre cross-sectional survey of adults visiting EDs. The patients answered the DNBH questions, and swabs were taken from the nose, throat and rectum. The collected samples were examined for MRSA and CPE. Screening performances were calculated.FINDINGS: Of the 5117 included patients, 16 were colonized with MRSA and four were colonized with CPE. The MRSA screening tool had sensitivity of 50% [95% confidence interval (CI) 25-75%] for carrier detection and 25% (95% CI 7-52%) for carrier isolation. The CPE screening tool had sensitivity of 25% (95% CI 1-81%) and none of the CPE carriers were isolated.CONCLUSION: The national screening tools were of limited use as the majority of MRSA and CPE carriers passed unidentified through the EDs, and many patients were isolated unnecessarily.
AB - BACKGROUND: Multi-resistant bacteria (MRB) are an emerging problem. Early identification of patients colonized with MRB is mandatory to avoid in-hospital transmission and to target antibiotic treatment. Since most patients pass through specialized emergency departments (EDs), these departments are crucial in early identification. The Danish National Board of Health (DNBH) has developed exposure-based targeted screening tools to identify and isolate carriers of meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE).AIM: To assess the national screening tools for detection of MRSA and CPE carriage in a cohort of acute patients. The objectives were to investigate: (i) if the colonized patients were detected; and (ii) if the colonized patients were isolated.METHODS: This was a multi-centre cross-sectional survey of adults visiting EDs. The patients answered the DNBH questions, and swabs were taken from the nose, throat and rectum. The collected samples were examined for MRSA and CPE. Screening performances were calculated.FINDINGS: Of the 5117 included patients, 16 were colonized with MRSA and four were colonized with CPE. The MRSA screening tool had sensitivity of 50% [95% confidence interval (CI) 25-75%] for carrier detection and 25% (95% CI 7-52%) for carrier isolation. The CPE screening tool had sensitivity of 25% (95% CI 1-81%) and none of the CPE carriers were isolated.CONCLUSION: The national screening tools were of limited use as the majority of MRSA and CPE carriers passed unidentified through the EDs, and many patients were isolated unnecessarily.
KW - CPE
KW - Emergency department
KW - Isolation
KW - MRSA
KW - Multi-resistant bacteria
KW - Screening tool
KW - Carrier State/microbiology
KW - Humans
KW - Middle Aged
KW - Male
KW - Anti-Bacterial Agents/pharmacology
KW - Rectum/microbiology
KW - Methicillin-Resistant Staphylococcus aureus/drug effects
KW - Drug Resistance, Multiple, Bacterial/drug effects
KW - Carbapenem-Resistant Enterobacteriaceae/drug effects
KW - Female
KW - Staphylococcal Infections/epidemiology
KW - Cross Infection/prevention & control
KW - Cross-Sectional Studies
KW - Mass Screening/standards
KW - Risk Factors
KW - Enterobacteriaceae Infections/epidemiology
KW - Denmark/epidemiology
KW - Patient Isolation/statistics & numerical data
KW - Aged
KW - Emergency Service, Hospital/statistics & numerical data
KW - Infection Control/methods
U2 - 10.1016/j.jhin.2019.08.024
DO - 10.1016/j.jhin.2019.08.024
M3 - Journal article
C2 - 31494129
SN - 0195-6701
VL - 104
SP - 27
EP - 32
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
IS - 1
ER -