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Jon P. Furuno, PhD; Jessina C. McGregor, PhD; Anthony D. Harris, MD, MPH; Judith A. Johnson, PhD; Jennifer K. Johnson, PhD; Patricia Langenberg, PhD; Richard A. Venezia, PhD; Joseph Finkelstein, MD; David L. Smith, PhD; Sandra M. Strauss, BS, M(ASCP); Eli N. Perencevich, MD, MS

Arch Intern Med. 2006;166:580-585.

Background  No simple, cost-effective methods exist to identify patients at high risk for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization outside intensive care settings. Without such methods, colonized patients are entering hospitals undetected and transmitting these bacteria to other patients. We aimed to develop a highly sensitive, simple-to-administer prediction rule to identify subpopulations of patients at high risk for colonization on hospital admission.

Methods  We conducted a prospective cohort study of adult patients admitted to the general medical and surgical wards of a tertiary-care facility. Data were collected using electronic medical records and an investigator-administered questionnaire. Cultures of anterior nares and the perirectal area were also collected within 48 hours of admission.

Results  Among 699 patients who enrolled in this study, 697 underwent nasal cultures; 555, perirectal cultures; and 553, both. Patient self-report of a hospital admission in the previous year was the most sensitive variable in identifying patients colonized with methicillin-resistant Staphylococcus aureus or with either organism (sensitivity, 76% and 90%, respectively). A prediction rule requiring patients to self-report having received antibiotics and a hospital admission in the previous year would have identified 100% of patients colonized with vancomycin-resistant enterococci. In the high-risk groups defined by the prediction rule, the prevalence of colonization by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or either organism were 8.1%, 10.2%, and 15.0%, respectively.

Conclusion  Patients with a self-reported previous admission within 1 year may represent a high-risk group for colonization by methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci at hospital admission and should be considered for targeted active surveillance culturing.

Author Affiliations: Departments of Epidemiology and Preventive Medicine (Drs Furuno, McGregor, Harris, Langenberg, Finkelstein, Smith, and Perencevich and Ms Strauss) and Pathology (Drs J. A. Johnson, J. K. Johnson, and Venezia), University of Maryland School of Medicine, and Veterans Affairs Maryland Health Care System (Drs Harris, J. A. Johnson, and Perencevich), Baltimore; and Fogarty International Center, National Institutes of Health, Bethesda, Md (Dr Smith).

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