MRSA, VRE: SHEA urges active screening cultures

MRSA, VRE: SHEA urges active screening cultures

Breaks with CDC in call for aggressive measures

Muto CA, Jernigan JA, Ostrowsky BE, et al. Special Report: SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003; 24:362-386.

Rather than merely isolating patients with known infections, infection control professionals should screen patients aggressively for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), according to new guidelines by the Society for Healthcare Epidemiology of America (SHEA).

The new guidelines recommend the practice so that those who are colonized or infected can be placed in contact isolation rather than serving as an undetected reservoir to spread the pathogens to other patients. Frequent antibiotic therapy in health care settings provides a selective advantage for resistant flora, but patients with MRSA or VRE usually acquire it via spread. The Centers for Disease Control and Prevention (CDC) has long recommended contact precautions for patients colonized or infected with such pathogens, but not active screening to detect them.

"Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC’s long-recommended contact precautions," the authors emphasized.

Current CDC guidelines do not recommend such active screening as a routine measure, but the CDC’s Healthcare Infection Control Practices Advisory Committee is in the process of developing new guidelines for antibiotic-resistant pathogens. "Infection control programs were created three decades ago to control antibiotic-resistant health care-associated infections, but there has been little evidence of control in most facilities," the SHEA authors argue.

SHEA made reducing antibiotic-resistant infections a strategic goal in January 2000. After two more years without improvement, a SHEA task force was appointed to draft this evidence-based guideline on preventing nosocomial transmission of such pathogens, focusing on the two considered most out of control: MRSA and VRE.

Medline searches were conducted spanning 1966 to 2002. Pertinent abstracts of unpublished studies providing sufficient data were included.

"Most facilities have required this as policy but have not actively identified colonized patients with surveillance cultures, leaving most colonized patients undetected and unisolated," the authors conclude. "Many studies have shown control of endemic and/or epidemic MRSA and VRE infections using surveillance cultures and contact precautions."