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Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial

DESIGN: Cluster randomised crossover trial with seven wards randomly allocated to intervention or control arm. SETTING: Medical and surgical wards of a university hospital with active MRSA control programme. PARTICIPANTS: All patients hospitalized >48 h in study wards and screened for MRSA on adm...

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Autores principales: Roisin, Sandrine, Laurent, Christine, Denis, Olivier, Dramaix, Michèle, Nonhoff, Claire, Hallin, Marie, Byl, Baudouin, Struelens, Marc J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023928/
https://www.ncbi.nlm.nih.gov/pubmed/24836438
http://dx.doi.org/10.1371/journal.pone.0096310
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author Roisin, Sandrine
Laurent, Christine
Denis, Olivier
Dramaix, Michèle
Nonhoff, Claire
Hallin, Marie
Byl, Baudouin
Struelens, Marc J.
author_facet Roisin, Sandrine
Laurent, Christine
Denis, Olivier
Dramaix, Michèle
Nonhoff, Claire
Hallin, Marie
Byl, Baudouin
Struelens, Marc J.
author_sort Roisin, Sandrine
collection PubMed
description DESIGN: Cluster randomised crossover trial with seven wards randomly allocated to intervention or control arm. SETTING: Medical and surgical wards of a university hospital with active MRSA control programme. PARTICIPANTS: All patients hospitalized >48 h in study wards and screened for MRSA on admission and discharge Intervention: Rapid PCR-based screening test for MRSA compared with control screening test by enrichment culture using chromogenic agar. OBJECTIVE: We determined the benefit of PCR-detection versus culture-based detection of MRSA colonisation upon patient admission on early implementation of isolation precautions and reduction of hospital transmission of MRSA. MAIN OUTCOME: Cumulative rate of MRSA hospital acquisition of in patients screened negative on admission. RANDOMIZATION: The sequential order of inclusion of study wards in each arm was randomised by assigning a number to each ward and using a computer generated list of random numbers. FINDINGS: Of 3704 eligible patients, 67.8% were evaluable for the study. Compared with culture, PCR-screening reduced the median test reporting time from admission from 88 to 11 hours (p<0.001) and the median time from admission to isolation from 96 to 25 hours (p<0.001). MRSA acquisition was detected in 36 patients (3.2%) in the control arm and 34 (3.2%) in the intervention arm. The incidence density rate of hospital acquired MRSA was 2.82 and 2.57/1,000 exposed patient-days in the control and intervention arm, respectively (risk ratio 0.91 (95% confidence interval, 0.60–1.39). Poisson regression model adjusted for colonisation pressure, compliance with hand hygiene and antibiotic use indicated a RR 0.99 (95% CI, 0.69 to 1.44). INTERPRETATION: Universal PCR screening for MRSA on admission to medical and surgical wards in an endemic setting shortened the time to implement isolation precautions but did not reduce nosocomial acquisition of MRSA. TRIAL REGISTRATION: clinicaltrials.gov NCT00846105
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spelling pubmed-40239282014-05-21 Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial Roisin, Sandrine Laurent, Christine Denis, Olivier Dramaix, Michèle Nonhoff, Claire Hallin, Marie Byl, Baudouin Struelens, Marc J. PLoS One Research Article DESIGN: Cluster randomised crossover trial with seven wards randomly allocated to intervention or control arm. SETTING: Medical and surgical wards of a university hospital with active MRSA control programme. PARTICIPANTS: All patients hospitalized >48 h in study wards and screened for MRSA on admission and discharge Intervention: Rapid PCR-based screening test for MRSA compared with control screening test by enrichment culture using chromogenic agar. OBJECTIVE: We determined the benefit of PCR-detection versus culture-based detection of MRSA colonisation upon patient admission on early implementation of isolation precautions and reduction of hospital transmission of MRSA. MAIN OUTCOME: Cumulative rate of MRSA hospital acquisition of in patients screened negative on admission. RANDOMIZATION: The sequential order of inclusion of study wards in each arm was randomised by assigning a number to each ward and using a computer generated list of random numbers. FINDINGS: Of 3704 eligible patients, 67.8% were evaluable for the study. Compared with culture, PCR-screening reduced the median test reporting time from admission from 88 to 11 hours (p<0.001) and the median time from admission to isolation from 96 to 25 hours (p<0.001). MRSA acquisition was detected in 36 patients (3.2%) in the control arm and 34 (3.2%) in the intervention arm. The incidence density rate of hospital acquired MRSA was 2.82 and 2.57/1,000 exposed patient-days in the control and intervention arm, respectively (risk ratio 0.91 (95% confidence interval, 0.60–1.39). Poisson regression model adjusted for colonisation pressure, compliance with hand hygiene and antibiotic use indicated a RR 0.99 (95% CI, 0.69 to 1.44). INTERPRETATION: Universal PCR screening for MRSA on admission to medical and surgical wards in an endemic setting shortened the time to implement isolation precautions but did not reduce nosocomial acquisition of MRSA. TRIAL REGISTRATION: clinicaltrials.gov NCT00846105 Public Library of Science 2014-05-16 /pmc/articles/PMC4023928/ /pubmed/24836438 http://dx.doi.org/10.1371/journal.pone.0096310 Text en © 2014 Roisin et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Roisin, Sandrine
Laurent, Christine
Denis, Olivier
Dramaix, Michèle
Nonhoff, Claire
Hallin, Marie
Byl, Baudouin
Struelens, Marc J.
Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial
title Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial
title_full Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial
title_fullStr Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial
title_full_unstemmed Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial
title_short Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial
title_sort impact of rapid molecular screening at hospital admission on nosocomial transmission of methicillin-resistant staphylococcus aureus: cluster randomised trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023928/
https://www.ncbi.nlm.nih.gov/pubmed/24836438
http://dx.doi.org/10.1371/journal.pone.0096310
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