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Discontinuation of Contact Precautions for Methicillin-Resistant Staphylococcus aureus (MRSA): A Randomized Controlled Trial Comparing Passive and Active Screening with Culture and Polymerase Chain Reaction.
Clin Infect Dis. 2013 Apr 9;
Authors: Shenoy ES, Kim J, Rosenberg ES, Cotter JA, Lee H, Walensky RP, Hooper DC
Abstract
Background. There have been no randomized controlled trials comparing active and passive screening for documenting clearance of colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the efficacy of active and passive screening using both culture and commercial polymerase chain reaction (PCR) for documentation of MRSA clearance and discontinuation of MRSA Contact Precautions (CP). Methods. Inpatients with a history of MRSA infection or colonization enrolled between December 2010 and September 2011 were randomized to either passive (Non-Intervention Arm; n=202; observation with local standard of care [SOC]) or active screening (Intervention Arm; n=405; study staff screened using culture and commercial polymerase chain reaction (PCR).The primary outcome was discontinuation of CP by trial arm based on three negative cultures. In the Intervention Arm, sensitivity, specificity, and positive and negative predictive value of the first PCR were compared to cultures. Results. CP were discontinued significantly more often (rate ratio [RR], 4.1; 95% confidence interval [CI], 2.3%-7.1%) in the Intervention Arm, including in an intent-to-screen analysis (RR, 2.6; 95% CI, 1.5%-4.7%).The first PCR, compared to three cultures, detected MRSA with a sensitivity of 93.9% (95% CI, 85.4%-97.6%), a specificity of 92.0% (95% CI, 85.9%-95.6%), a positive predictive value of 86.1% (95% CI, 75.9%-93.1%) and a negative predictive value of 96.6% (95% CI, 91.6%-99.1%). Conclusions. Compared to passive screening using culture methods, active screening resulted in discontinuation of MRSA CP at a significantly higher frequency. Active screening with a single PCR would significantly increase the completion of the screening process.
PMID: 23572482 [PubMed - as supplied by publisher]