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J Hosp Infect. 2020 Jan;104(1):27-32. doi: 10.1016/j.jhin.2019.08.024. Epub 2019 Sep 5.

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

Author information

1
Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark. Electronic address: Helene.Skjoet-Arkil@rsyd.dk.
2
Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
3
Emergency Department, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
4
Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
5
Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark; Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark.
6
Emergency Department, Regional Hospital West Jutland, Herning, Denmark.
7
Emergency Department, Aarhus University Hospital, Aarhus, Denmark.
8
Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
9
Emergency Department, Aalborg University Hospital, Aalborg, Denmark.
10
Emergency Department, North Denmark Regional Hospital, Hjørring, Denmark.
11
Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.
12
Emergency Department, Slagelse Hospital, Slagelse, Denmark.
13
Emergency Department, Zealand University Hospital, Køge, Denmark.
14
Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.
15
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.

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

PMID:
31494129
DOI:
10.1016/j.jhin.2019.08.024
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