Identifying groups at high risk for carriage of antibiotic-resistant bacteria

Jon P. Furuno, Jessina C. McGregor, Anthony D. Harris, Judith A. Johnson, Jennifer K. Johnson, Patricia Langenberg, Richard A. Venezia, Joseph Finkelstein, David L. Smith, Sandra M. Strauss, Eli N. Perencevich

Research output: Contribution to journalArticle

Abstract

Background: No simple, cost-effective methods exist to identify patients at high risk for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization outside intensive care settings. Without such methods, colonized patients are entering hospitals undetected and transmitting these bacteria to other patients. We aimed to develop a highly sensitive, simple-to-administer prediction rule to identify subpopulations of patients at high risk for colonization on hospital admission. Methods: We conducted a prospective cohort study of adult patients admitted to the general medical and surgical wards of a tertiary-care facility. Data were collected using electronic medical records and an investigator-administered questionnaire. Cultures of anterior nares and the perirectal area were also collected within 48 hours of admission. Results: Among 699 patients who enrolled in this study, 697 underwent nasal cultures; 555, perirectal cultures; and 553, both. Patient self-report of a hospital admission in the previous year was the most sensitive variable in identifying patients colonized with methicillin-resistant Staphylococcus aureus or with either organism (sensitivity, 76% and 90%, respectively). A prediction rule requiring patients to self-report having received antibiotics and a hospital admission in the previous year would have identified 100% of patients colonized with vancomycin-resistant enterococci. In the high-risk groups defined by the prediction rule, the prevalence of colonization by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or either organism were 8.1%, 10.2%, and 15.0%, respectively. Conclusion: Patients with a self-reported previous admission within 1 year may represent a high-risk group for colonization by methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci at hospital admission and should be considered for targeted active surveillance culturing.

Original languageEnglish (US)
Pages (from-to)580-585
Number of pages6
JournalArchives of Internal Medicine
Volume166
Issue number5
DOIs
StatePublished - Mar 13 2006
Externally publishedYes

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Anti-Bacterial Agents
Bacteria
Methicillin-Resistant Staphylococcus aureus
Self Report
Electronic Health Records
Tertiary Healthcare
Critical Care
Nose
Cohort Studies
Research Personnel
Prospective Studies
Costs and Cost Analysis
Vancomycin-Resistant Enterococci

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Furuno, J. P., McGregor, J. C., Harris, A. D., Johnson, J. A., Johnson, J. K., Langenberg, P., ... Perencevich, E. N. (2006). Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Archives of Internal Medicine, 166(5), 580-585. https://doi.org/10.1001/archinte.166.5.580

Identifying groups at high risk for carriage of antibiotic-resistant bacteria. / Furuno, Jon P.; McGregor, Jessina C.; Harris, Anthony D.; Johnson, Judith A.; Johnson, Jennifer K.; Langenberg, Patricia; Venezia, Richard A.; Finkelstein, Joseph; Smith, David L.; Strauss, Sandra M.; Perencevich, Eli N.

In: Archives of Internal Medicine, Vol. 166, No. 5, 13.03.2006, p. 580-585.

Research output: Contribution to journalArticle

Furuno, JP, McGregor, JC, Harris, AD, Johnson, JA, Johnson, JK, Langenberg, P, Venezia, RA, Finkelstein, J, Smith, DL, Strauss, SM & Perencevich, EN 2006, 'Identifying groups at high risk for carriage of antibiotic-resistant bacteria', Archives of Internal Medicine, vol. 166, no. 5, pp. 580-585. https://doi.org/10.1001/archinte.166.5.580
Furuno JP, McGregor JC, Harris AD, Johnson JA, Johnson JK, Langenberg P et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Archives of Internal Medicine. 2006 Mar 13;166(5):580-585. https://doi.org/10.1001/archinte.166.5.580
Furuno, Jon P. ; McGregor, Jessina C. ; Harris, Anthony D. ; Johnson, Judith A. ; Johnson, Jennifer K. ; Langenberg, Patricia ; Venezia, Richard A. ; Finkelstein, Joseph ; Smith, David L. ; Strauss, Sandra M. ; Perencevich, Eli N. / Identifying groups at high risk for carriage of antibiotic-resistant bacteria. In: Archives of Internal Medicine. 2006 ; Vol. 166, No. 5. pp. 580-585.
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abstract = "Background: No simple, cost-effective methods exist to identify patients at high risk for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization outside intensive care settings. Without such methods, colonized patients are entering hospitals undetected and transmitting these bacteria to other patients. We aimed to develop a highly sensitive, simple-to-administer prediction rule to identify subpopulations of patients at high risk for colonization on hospital admission. Methods: We conducted a prospective cohort study of adult patients admitted to the general medical and surgical wards of a tertiary-care facility. Data were collected using electronic medical records and an investigator-administered questionnaire. Cultures of anterior nares and the perirectal area were also collected within 48 hours of admission. Results: Among 699 patients who enrolled in this study, 697 underwent nasal cultures; 555, perirectal cultures; and 553, both. Patient self-report of a hospital admission in the previous year was the most sensitive variable in identifying patients colonized with methicillin-resistant Staphylococcus aureus or with either organism (sensitivity, 76{\%} and 90{\%}, respectively). A prediction rule requiring patients to self-report having received antibiotics and a hospital admission in the previous year would have identified 100{\%} of patients colonized with vancomycin-resistant enterococci. In the high-risk groups defined by the prediction rule, the prevalence of colonization by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or either organism were 8.1{\%}, 10.2{\%}, and 15.0{\%}, respectively. Conclusion: Patients with a self-reported previous admission within 1 year may represent a high-risk group for colonization by methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci at hospital admission and should be considered for targeted active surveillance culturing.",
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AU - McGregor, Jessina C.

AU - Harris, Anthony D.

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AU - Johnson, Jennifer K.

AU - Langenberg, Patricia

AU - Venezia, Richard A.

AU - Finkelstein, Joseph

AU - Smith, David L.

AU - Strauss, Sandra M.

AU - Perencevich, Eli N.

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N2 - Background: No simple, cost-effective methods exist to identify patients at high risk for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization outside intensive care settings. Without such methods, colonized patients are entering hospitals undetected and transmitting these bacteria to other patients. We aimed to develop a highly sensitive, simple-to-administer prediction rule to identify subpopulations of patients at high risk for colonization on hospital admission. Methods: We conducted a prospective cohort study of adult patients admitted to the general medical and surgical wards of a tertiary-care facility. Data were collected using electronic medical records and an investigator-administered questionnaire. Cultures of anterior nares and the perirectal area were also collected within 48 hours of admission. Results: Among 699 patients who enrolled in this study, 697 underwent nasal cultures; 555, perirectal cultures; and 553, both. Patient self-report of a hospital admission in the previous year was the most sensitive variable in identifying patients colonized with methicillin-resistant Staphylococcus aureus or with either organism (sensitivity, 76% and 90%, respectively). A prediction rule requiring patients to self-report having received antibiotics and a hospital admission in the previous year would have identified 100% of patients colonized with vancomycin-resistant enterococci. In the high-risk groups defined by the prediction rule, the prevalence of colonization by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or either organism were 8.1%, 10.2%, and 15.0%, respectively. Conclusion: Patients with a self-reported previous admission within 1 year may represent a high-risk group for colonization by methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci at hospital admission and should be considered for targeted active surveillance culturing.

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