Elimination of routine screening and contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus bacteremia

Bianca B.P. SantosHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil

Lorena P.S. LimaHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil

Luana M. CorreaHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil

Adriana O. AssumpçãoHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil

Priscila P.C. OliveiraHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil

Priscilla M. MonteiroHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil

Sérgio M. MorgadoLaboratory of Molecular Genetics of Microorganisms, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

Luiz A. MascarenhasHospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, RJ, Brazil; & Medical clinic Estácio de Sá University, Rio de Janeiro, RJ, Brazil

DOI:

https://doi.org/10.3396/ijic.v19.23241

Keywords:

Staphylococcus, Enterococcus, hospital, ICU, bacteremia, contact precautions

Abstract

Intensive care units (ICUs) are high-risk areas for transmission of antibiotic-resistant bacteria, mainly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) (1). Effort to control these organisms include contact precautions (CPs), being first recommended by the Centers for Disease Control and Prevention in 1970 (2). However, bacterial infections still occur, such as those caused by MRSA, the most common pathogen in catheter-associated infections (3), and VRE, which has been reported with increased prevalence in the world (4). In fact, there is little evidence to support the effectiveness of CP in the prevention of some bacterial infections, such as MRSA and VRE infections (5–8). In addition, reports suggesting that CPs prevent MRSA or VRE infections are in the context of outbreaks rather than endemics, the latter being a key concern for hospitals (8). Thus, there are limited controlled data demonstrating screening and CP to prevent MRSA and VRE infections in an endemic setting. Our study aimed to determine the impact of CP on the incidence of MRSA and VRE bacteremia before and after discontinuing these interventions in endemic settings. 

How to Cite:

Santos, B. B., Lima, L. P., Correa, L. M., Assumpção, A. O., Oliveira, P. P., Monteiro, P. M., … Mascarenhas, L. A. (2023). Elimination of routine screening and contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus bacteremia: a retrospective study in intensive care units in Brazil. International Journal of Infection Control, 19. https://doi.org/10.3396/ijic.v19.23241

References

1. Huskins WC, Huckabee CM, O’Grady NP, Murray P, Kopetskie H, Zimmer L, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011; 364(15): 1407–18. doi: 10.1056/NEJMoa1000373

2. Siegel JD, Rhinehart E, Jackson M, Chiarello L. The Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in health care setting, 2007. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html [cited 22 July 2022].

3. Gebreselassie HM, Kaspar T, Droz S, Marschall J. Low yield of methicillin-resistant Staphylococcus aureus screening in hemodialysis patients: 10 years’ experience. Infect Control Hosp Epidemiol 2015; 36(9): 1046. doi: 10.1017/ice.2015.117

4. Willems RJL, Top J, van Santen M, Robinson DA, Coque TM, Baquero F, et al. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex. Emerg Infect Dis 2005; 11(6): 821–8. doi: 10.3201/1106.041204

5. Drum BE, Collinsworth K, Arnoldo BD, Sreeramoju PV. Hospital-onset bloodstream infection rates after discontinuing active surveillance cultures for methicillin-resistant Staphylococcus aureus in a regional burn center. Infect Control Hosp Epidemiol 2017; 38(3): 371–2. doi: 10.1017/ice.2016.280

6. Derde LPG, Cooper BS, Goossens H, Malhotra-Kumar S, Willems RJL, Gniadkowski M, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014; 14(1): 31–9. doi: 10.1016/S1473-3099(13)70295-0

7. Harris AD, Pineles L, Belton B, Johnson JK, Shardel M, Loeb M. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013; 310(15): 1571–80. doi: 10.1001/jama.2013.277815

8. Morgan DJ, Wenzel RP, Bearman G. Contact precautions for endemic MRSA and VRE: time to retire legal mandates. JAMA 2017; 318(4): 329–30. doi: 10.1001/jama.2017.7419

9. Clinical and Laboratory Standards Institute. M100-S15. Performance standards for antimicrobial susceptibility testing, 15th Informational Supplement. Wayne, PA: CLSI; 2005.

10. Johnson AT, Nygaard RM, Cohen EM, Fey RM, Wagner AL. The impact of a universal decolonization protocol on hospital-acquired methicillin-resistant Staphylococcus aureus in a burn population. J Burn Care Res 2016; 37(6): e525–30. doi: 10.1097/BCR.0000000000000301

11. Shenoy ES, Lee H, Hou T, Ware W, Ryan EE, Hooper DC, et al. The impact of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) flags on hospital operations. Infect Control Hosp Epidemiol 2016; 37(7): 782–90. doi: 10.1017/ice.2016.54

12. Marra AR, Edmond MB, Schweizer ML, Ryan GW, Diekema DJ. Discontinuing contact precautions for multidrug-resistant organisms: a systematic literature review and meta-analysis. Am J Infect Control 2018; 46: 333–40. doi: 10.1016/j.ajic.2017.08.031

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