Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines

H Skjøt-Arkil; C B Mogensen; A T Lassen; I S Johansen; M Chen; P Petersen; K V Andersen; S Ellermann-Eriksen; J M Møller; M Ludwig; D Fuglsang-Damgaard; F E Nielsen; D B Petersen; U S Jensen; F S Rosenvinge

doi:10.1016/j.jhin.2019.08.024

Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines

H Skjøt-Arkil, C B Mogensen, A T Lassen, I S Johansen, M Chen, P Petersen, K V Andersen, S Ellermann-Eriksen, J M Møller, M Ludwig, D Fuglsang-Damgaard, F E Nielsen, D B Petersen, U S Jensen, F S Rosenvinge

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

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.

Original language	English
Journal	Journal of Hospital Infection
Volume	104
Issue	1
Pages (from-to)	27-32
Number of pages	6
ISSN	0195-6701
DOIs	https://doi.org/10.1016/j.jhin.2019.08.024
Publication status	Published - 2020

Keywords

CPE
Emergency department
Isolation
MRSA
Multi-resistant bacteria
Screening tool
Carrier State/microbiology
Humans
Middle Aged
Male
Anti-Bacterial Agents/pharmacology
Rectum/microbiology
Methicillin-Resistant Staphylococcus aureus/drug effects
Drug Resistance, Multiple, Bacterial/drug effects
Carbapenem-Resistant Enterobacteriaceae/drug effects
Female
Staphylococcal Infections/epidemiology
Cross Infection/prevention & control
Cross-Sectional Studies
Mass Screening/standards
Risk Factors
Enterobacteriaceae Infections/epidemiology
Denmark/epidemiology
Patient Isolation/statistics & numerical data
Aged
Emergency Service, Hospital/statistics & numerical data
Infection Control/methods

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10.1016/j.jhin.2019.08.024Licence: CC BY-NC-ND

1-s2.0-S0195670119303597-mainFinal published version, 252 KBLicence: CC BY-NC-ND

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Skjøt-Arkil, H., Mogensen, C. B., Lassen, A. T., Johansen, I. S., Chen, M., Petersen, P., Andersen, K. V., Ellermann-Eriksen, S., Møller, J. M., Ludwig, M., Fuglsang-Damgaard, D., Nielsen, F. E., Petersen, D. B., Jensen, U. S., & Rosenvinge, F. S. (2020). Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines. Journal of Hospital Infection, 104(1), 27-32. https://doi.org/10.1016/j.jhin.2019.08.024

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title = "Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines",

abstract = "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.",

keywords = "CPE, Emergency department, Isolation, MRSA, Multi-resistant bacteria, Screening tool, Carrier State/microbiology, Humans, Middle Aged, Male, Anti-Bacterial Agents/pharmacology, Rectum/microbiology, Methicillin-Resistant Staphylococcus aureus/drug effects, Drug Resistance, Multiple, Bacterial/drug effects, Carbapenem-Resistant Enterobacteriaceae/drug effects, Female, Staphylococcal Infections/epidemiology, Cross Infection/prevention & control, Cross-Sectional Studies, Mass Screening/standards, Risk Factors, Enterobacteriaceae Infections/epidemiology, Denmark/epidemiology, Patient Isolation/statistics & numerical data, Aged, Emergency Service, Hospital/statistics & numerical data, Infection Control/methods",

author = "H Skj{\o}t-Arkil and Mogensen, {C B} and Lassen, {A T} and Johansen, {I S} and M Chen and P Petersen and Andersen, {K V} and S Ellermann-Eriksen and M{\o}ller, {J M} and M Ludwig and D Fuglsang-Damgaard and Nielsen, {F E} and Petersen, {D B} and Jensen, {U S} and Rosenvinge, {F S}",

year = "2020",

doi = "10.1016/j.jhin.2019.08.024",

language = "English",

volume = "104",

pages = "27--32",

journal = "Journal of Hospital Infection",

issn = "0195-6701",

publisher = "W.B. Saunders Ltd",

number = "1",

}

Skjøt-Arkil, H, Mogensen, CB, Lassen, AT, Johansen, IS, Chen, M, Petersen, P, Andersen, KV, Ellermann-Eriksen, S, Møller, JM, Ludwig, M, Fuglsang-Damgaard, D, Nielsen, FE, Petersen, DB, Jensen, US & Rosenvinge, FS 2020, 'Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines', Journal of Hospital Infection, vol. 104, no. 1, pp. 27-32. https://doi.org/10.1016/j.jhin.2019.08.024

Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines. / Skjøt-Arkil, H; Mogensen, C B; Lassen, A T et al.
In: Journal of Hospital Infection, Vol. 104, No. 1, 2020, p. 27-32.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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

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 -

Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments: evaluation of national screening guidelines

Abstract

Keywords

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