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Simplified screening in an emergency department detected methicillin-resistant Staphylococcus aureus

Authors
Christian Backer Mogensen1, Poul Kjældgaard2, Charlotte Jensen1 & Ming Chen2, 1) Emergency Department, Southern Jutland Hospital2) Department of Clinical Microbiology, Southern Jutland Hospital, Denmark

Abstract

Introduction: All patients admitted to Danish hospitals are screened for methicillin-resistant Staphylococcus aureus (MRSA) by a questionnaire consisting of 19 questions issued by the Danish Health and Medicines Authority (DHMA). This study aimed to evaluate which of the questions were most useful. Furthermore, we assessed if other questions were more adequate and if a simplified screening model would perform equal to or better than the one presently used.

Methods: Swabs were obtained for MRSA culture from patients who were more than ten years old and who had been admitted to an emergency department (ED). All DHMA questions together with a range of additional questions were answered.

Results: Among the 1,220 patients who participated, 0.9% were MRSA carriers. Only three DHMA questions were associated with a significant risk of MRSA carriage. The additional questions associated with MRSA were “stayed with a non-Danish family within the past three years” and “daily contact with children at a nursery or kindergarten”. A new model with only five questions increased the sensitivity insignificantly from 18-55% to 73% in the revised model, whereas no changes were seen for specificity, predictive values or likelihood ratios.

Conclusion: The DHMA’s targeted screening for MRSA detection contained only few questions with significant association to MRSA carrier stage. A model based on only five questions seems to insignificantly improve the MRSA screening in this population. In order to develop a more simple and effective screening model, we recommend that our findings be tested in another ED patient population.

Funding: Southern Jutland Hospital funded this study.

Trial registration: not relevant.

The burden of methicillin-resistant Staphylococcus aureus (MRSA) varies between countries. In Denmark, the prevalence has increased in the past decade [1]. New MRSA strains have been identified which are associated with pig farming [2], but many other strains have been isolated as well, suggesting that there are multiple sources of community-acquired MRSA [3]. Since the majority of patients who are admitted to hospital pass through the emergency departments (ED), the EDs play a crucial role in early identification of MRSA carriers. All patients admitted to Danish hospitals are...
Bib ref: 
Dan Med J 2016;63(2):A5195
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