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

Helene Skjøt-Arkil, Christian B Mogensen, Annmarie T Lassen, Isik S Johansen, Ming Chen, Poul Petersen, Karen V Andersen, Svend Ellermann-Eriksen, Jørn M Møller, Marc Ludwig, David Fuglsang-Damgaard, Finn Erland Nielsen, Dan B Petersen, Ulrich S Jensen, Flemming S Rosenvinge

Research output: Contribution to journalJournal articleResearchpeer-review

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 languageEnglish
JournalJournal of Hospital Infection
Volume104
Issue number1
Pages (from-to)27-32
ISSN0195-6701
DOIs
Publication statusPublished - Jan 2020

Fingerprint

Methicillin
Hospital Emergency Service
Guidelines
Confidence Intervals
Health
Nose
Rectum
Cross-Sectional Studies

Keywords

  • CPE
  • Emergency department
  • Isolation
  • MRSA
  • Multi-resistant bacteria
  • Screening tool

Cite this

Skjøt-Arkil, Helene ; Mogensen, Christian B ; Lassen, Annmarie T ; Johansen, Isik S ; Chen, Ming ; Petersen, Poul ; Andersen, Karen V ; Ellermann-Eriksen, Svend ; Møller, Jørn M ; Ludwig, Marc ; Fuglsang-Damgaard, David ; Nielsen, Finn Erland ; Petersen, Dan B ; Jensen, Ulrich S ; Rosenvinge, Flemming S. / Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments - evaluation of national screening guidelines. In: Journal of Hospital Infection. 2020 ; Vol. 104, No. 1. pp. 27-32.
@article{17524c0547a34aaab80be0883428dcbd,
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",
author = "Helene Skj{\o}t-Arkil and Mogensen, {Christian B} and Lassen, {Annmarie T} and Johansen, {Isik S} and Ming Chen and Poul Petersen and Andersen, {Karen V} and Svend Ellermann-Eriksen and M{\o}ller, {J{\o}rn M} and Marc Ludwig and David Fuglsang-Damgaard and Nielsen, {Finn Erland} and Petersen, {Dan B} and Jensen, {Ulrich S} and Rosenvinge, {Flemming S}",
note = "Copyright {\circledC} 2019. Published by Elsevier Ltd.",
year = "2020",
month = "1",
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 Co. Ltd.",
number = "1",

}

Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments - evaluation of national screening guidelines. / Skjøt-Arkil, Helene; Mogensen, Christian B; Lassen, Annmarie T; Johansen, Isik S; Chen, Ming; Petersen, Poul; Andersen, Karen V; Ellermann-Eriksen, Svend; Møller, Jørn M; Ludwig, Marc; Fuglsang-Damgaard, David; Nielsen, Finn Erland; Petersen, Dan B; Jensen, Ulrich S; Rosenvinge, Flemming S.

In: Journal of Hospital Infection, Vol. 104, No. 1, 01.2020, p. 27-32.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments - evaluation of national screening guidelines

AU - Skjøt-Arkil, Helene

AU - Mogensen, Christian B

AU - Lassen, Annmarie T

AU - Johansen, Isik S

AU - Chen, Ming

AU - Petersen, Poul

AU - Andersen, Karen V

AU - Ellermann-Eriksen, Svend

AU - Møller, Jørn M

AU - Ludwig, Marc

AU - Fuglsang-Damgaard, David

AU - Nielsen, Finn Erland

AU - Petersen, Dan B

AU - Jensen, Ulrich S

AU - Rosenvinge, Flemming S

N1 - Copyright © 2019. Published by Elsevier Ltd.

PY - 2020/1

Y1 - 2020/1

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

U2 - 10.1016/j.jhin.2019.08.024

DO - 10.1016/j.jhin.2019.08.024

M3 - Journal article

C2 - 31494129

VL - 104

SP - 27

EP - 32

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

SN - 0195-6701

IS - 1

ER -