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Determination of a simple clinical score for screening of elderly patients at risk for MRSA carriage upon hospital admission in acute geriatric wards

Abstract number: P1764

Bettens S., Schoevaerdts D., Swine C., Delaere B., Glupczynski Y.

Objectives: MRSA transmission is an important public health problem in acute hospitals as well as in nursing homes and in the community. Furthermore, MRSA carriage plays an important role in the morbidity and mortality in the elderly. Screening at risk patients upon admission in geriatric units appears as a logical approach to prevent the spread of MRSA to frail elderly patients. We aimed to find a simple clinical score allowing to target accurately patients at higher risk of MRSA carriage while limiting at the same time both the nursing's extra-workload as well as the number of unnecessary laboratory analysis.

Patients and Methods: All consecutive patients admitted in our 27-bed acute geriatric unit from October 2006 to April 2007 were included prospectively in the trial. For each admitted patient, informations on 11 potential risk factors met in the literature were collected. Each risk factor was evaluated by an uni- and multivariate analysis (logistic regression). MRSA carriage was screened from nose, throat and skin swabs by conventional microbiological culture methods using selective chromogenic culture media.

Results: Overall 221 patients were admitted over the study period. MRSA carriage was observed in 22 patients. 6 of the 11 putative risk factors were significant by univariate analysis: age >86.9y (P = 0.002), prior MRSA carriage (P < 0.001), multiple hospitalisations (P < 0.001), chronic wounds (P < 0.001), prior antibiotherapy (P = 0.003), long-course catheters (P = 0.005). Following multivariate analysis, only the first 5 criteria were retained and we computed the score for each patient (1 point per risk factor). The medians were 2/5 points (95% IC: 1.40–3.00) for the MRSA-positive group and 1/5 points (0.00–1.00) for the MRSA-negative group (P < 0.0001). The sensitivity, specificity and negative predictive value were respectively 72.7%, 82.4% and 96.5% (cutoff >1 point; local prevalence= 10%).

Conclusion: We propose an "easy-to-use" scoring system in order to help geriatric nursing to target and screen only the patients at higher risk of MRSA carriage upon hospital admission. Patients with a score >1 were 12.5 fold more at risk (95% IC 4.56–34.19) than those with less than 2 points. In this study, the reliance on such a clinical score would have allowed to screen only 23% of the patients. Although promising, this simple clinical MRSA scoring system should be further evaluated in a larger cohort of patients, preferably in the setting of a multicentric study.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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