Research forum abstract
Poster session 2: Infectious disease
120: How Many Methicillin-Resistant Staphylococeus Aureus Infections Are Missed Upon Admission to the Emergency Department?

https://doi.org/10.1016/j.annemergmed.2009.06.147Get rights and content

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Study Objective

The objective of the study was to assess the carriage rates of methicillin-resistant Staphylococcus aureus (MRSA) at different body sites.

Background

MRSA is a significant cause of morbidity and mortality. Knowledge of frequently colonized sites may prevent nosocomial and post-procedural MRSA infection. Current practice focuses on the internal nares as the primary source. This study suggests that addition sites should be screened.

Methods

This prospective case cohort study was conducted at a university medical center. The internal nares, axilla and groin of eligble emergency department patients and visitors were cultured bilaterally. Eligible participants were adults with decisional capacity and minors who assented with parental or guardian consent. Swabs were plated on BBL CHROMagar MRSA plates. Agar plates were observed at 24 and 48 hours for growth. Suspected MRSA colonies were biochemically tested to confirm their identity.

Results

Among 93 participants, 82% cultured negative for MRSA, 16% had MRSA colonization at one site, while 2% cultured were positive at two sites. Of the positive cultures the nares(48%), groin (47%) and axilla (5%) were the most common sites of colonization. Approximately 53% of patients who cultured positive at least one site were positive in the groin, while the remaining 47% cultured positive from the internal nares. No participants cultured positive from all three sites.

Conclusion

The greatest proportions of ED patients were positive at the internal nares and groin respectively (48%, 47%). The internal nares and groin are likely sites of MRSA colonization but with minimal overlap. Based on this study nasal swabs alone do not provide a clear picture of MRSA prevalence in our patient population. Axillary swabbing is not an effective means of detecting MRSA carriage in our population.

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