Linda Formby

When should contact precautions be discontinued for patients with methicillin-resistant Staphylococcus aureus?

HighlightsThe proportion of patients with MRSA who remained positive by ASC was low (19.9%).This proportion decreased over time, with the lowest at 5 years (12.5%).Only 3.9% of patients with a negative ASC later had a positive MRSA culture.The presence of a foreign body increased the risk of having a MRSA positive culture.Patients with known MRSA and a negative ASC may not need contact precautions. &NA; When to discontinue contact precautions for patients with methicillin‐resistant Staphylococcus aureus (MRSA) remains unresolved and policies vary between hospitals. We prospectively performed admission active surveillance cultures on patients known to have been MRSA positive for at least 1 year to determine the proportion who remained positive. The proportion of patients with MRSA who remained positive was 19.9%; however, this significantly decreased over time, particularly after 5 years.

314When Should Contact Precautions be Discontinued for Patients with Methicillin-Resistant Staphylococcus aureus (MRSA)

Background. When to discontinue contact precautions (CP) for patients (pts) with MRSA remains unresolved and policies vary between hospitals. Our facility considers an MRSA patient positive (+) (and thus remaining in CP) until they have had two active surveillance cultures (ASC) return negative (-) or have undergone successful decolonization therapy. Methods. From October 2010-March 2014 we prospectively performed admission ASC (and weekly for those with (-) results) on pts known to have been MRSA (+) for at least 1 year to determine the proportion who remained MRSA (+). Characteristics (age, sex, race, hospitalization within the year, presence of a wound or foreign body, receipt of antibiotics, hemodialysis, and residence in a group setting) were collected from a chart review to determine factors associated with persistent carriage. Results. Over the study period 408 pts with MRSA had an admission ASC done a mean of 1671 days from their first known (+) MRSA culture (range 416 5668 days). Ultimately, 82 (20.1%) pts in the cohort had MRSA detected during the study. 68 (16.7%) of 408 had a (+) admission ASC. Of the 339 pts who had a (-) admission ASC, 181 (53.4%) had a second ASC culture and 8 (4.4%) were (+) for MRSA. Of the 173 pts who had two (-) ASC, 6 (3.5%) went on to have a future culture (+) for MRSA. Increased number of days between first known (+) MRSA culture to admission ASC was associated with a lower risk for having MRSA detected during the study (p= 0.04) and having the ASC performed more than 5 years since the first known (+) MRSA culture was associated with the lowest risk (OR 0.45, [0.25-0.79], p = 0.005). For example, 18 (12.5%) of 144 pts with an ASC done more than 5 years from their first known (+)MRSAvs 64 (24.2%) of 264 pts with an ASC done 5 years or less from their first known (+) MRSA culture had MRSA detected during the study. Presence of a foreign body significantly increased the risk for having a (+) MRSA culture (OR 1.36 [1.02-1.82], p= 0.05) and female sex significantly reduced the risk (OR 0.78 [0.60-1.00], p = 0.05). Conclusion. The proportion of pts with MRSA documented more than a year ago who remained (+) was 20.1% however this significantly decreased over time, particularly after 5 years. Our data also suggest that in the absence of a foreign body and especially among females, CP can be discontinued after one (-) admission ASC. Disclosures. C. Salgado, Wolters Kluwer Health: Editorial Assistance, Licensing agreement or royalty