Table 1.
Participants, bacteriological testing, and outcomes of MRSA testing for identification of sites of MRSA colonization
| Author name, country | Period of study | Study design | MRSA detection method | Swabbing method and site | Study population and size | MRSA positive number (%) | MRSA site colonization
|
Best site combination
|
|||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Nasal | Extra-nasal | Proportion to be missed if nasal alone | Two | Three | |||||||
| El-Bouri and El-Bouri,14 Wales | January 2010–November 2012 | Retrospective | Chromogenic MRSA medium/Columbia blood agar | Only simultaneously swabbed patients of all anatomical sites were accepted | Adults at high risk for MRSA due to frequent re-admission or others (4,769) | 925/4,769 (19.4%) | 467/925 (50.5%) | 458/925 (49.5%) | 365 (39.5%) | Throat/groin 74.5% (71.7–77.3) Nose/groin 72.1% (69.2–75) |
Throat/nose/groin 92% (90.1–93.6) Nose/throat/perineum 91% (88.9–92.7) |
| Currie et al,15 Canada | January 2004–June 2007 | Descriptive analysis | MSA-OX, MSA-FOX, MRSA-Select | First set of screening swabs | All surgical and medical patient with HA-MRSA risk factors (23,365) | 627/2,3365 (2.7%) | 419/627 (66.8%) | 208/627 (33.1%) | 160 (34%) | Nares/rectum 586/612 (96% 94–98) | |
| Jang et al,16 Republic of Korea | March 2010–February 2011 | Prospective observational | BBL™ CHROMagar™ MRSA medium | Swabbed at the time of admission, 48 hours after admission, and then weekly | Adult patients (282) | 59/282 (21%) | 20/59 (34%) | 39/59 (66.1%) | 66% | Nasal/throat 50/59 (84.7%) | Nasal/throat/rectum (94.9%) |
| Yang et al,17 USA | February 2005–October 2007 | Prospectively | MSA-OX | Swabbing once at anatomic sites in MRSA infected patients | Adults with SSTIs (117) | 48/71 (67%) | 23/71 (32.4%) | 17/71 (24%) | Nasal/inguinal (96%) | ||
| Datta et al,18 India | January 2009–June 2010 | Active surveillance | Blood agar and Mac Conkey agar and disc diffusion test using 30 ug cefoxitin disc on Mueller Hinton agar | Single anatomic swabbing | Adults in ICU (400) | 90/400 (22.5%) | 70/90 (77.8%) | 20/90 (22.2%) | 11 (12.2%) | Nose/throat 86/90 (95.5%), Throat/groin 84/90 (93.3%), Nose/groin 82/90 (91.1%) | |
| Girou et al,19 France | 1993–1996 | Prospective | Chapman agar | Swab from nasal, perineum, and axilla at admission and once a week | High-risk patients from MICU (3,686) | 150/3,686 (4.1%) | 35/45 (78.5%) | 16/45 (35.6%) | 5/45 (11%) | Nasal/perineum (88.9%) | Nasal/throat/perineum (98%) |
| Lauderdale et al,20 Taiwan | August 2005–February 2006 | Retrospective | Sheep blood agar (SBA) and CHROM agar MRSA and broth-enriched culture | Swab sample set of nose, throat or sputum, axilla, and perineum within 24 hours admission | Patients on admission to a medical and surgicaI ICU (650) | 65/650 (10%) Direct culture (157/650 [24%] broth-enriched) | 114/157 (72.6%) | 43/157 (27.3%) | 27 (17.2%) | Nasal/throat 134/157 (85.4%) | Nasal/throat/perineum 146/157 (93.2%) |
| Eveillard et al,21 France | July 2002–June 2003 | Prospective | Mannitol salt agar (MSA-Ofloxacin) | Screen swab at different anatomic sites on admission and also clinical sample and TID calculated | 1,250 from ICU and other wards | 123/1,250 (9.8%) | 53/123 (43.1%) | 70/123 (56.9%) | 54.3% | Nose/rectum (91.9%) | Nose/axilla/rectum (100%) |
| Hombach et al,22 Switzerland | August 2007–August 2008 | Prospective | BD GeneOhm™ MRSA Assay, the Xpert™ MRSA assay and broth-enriched culture | Swabs from different sites on admission from MRSA high-risk patients | 425 | 29/425 (6.8%) | 26/29 (89.7%) | 22/29 (76%) | ≤1 | Nose/groin (100%) | |
| Baker et al,23 USA | October 2008–February 2009 | Prospective | Chromogenic agar plate | Swabs from acute care patients within 36 hours of admission | 150 | 16/150 (10.7%) | 9/16 (56.2%) | 6/16 (37.5%) | 3 (2%) | Nasal/oropharynx (62.5%) | Nasal/oropharynx/perineum (81%) |
| Mermel et al,24 USA | September 2007–March 2008 | Retrospective | MRSA-selective chromogenic medium and sheep blood agar | Adults inpatients previously identified as MRSA positive during the year prior to enrollment | 53 | Not stated | 48/53 (91%) | 40/53 (75.5%) | Similar sensitivity but combined samples increasing negative predictive value | Nares/groin (98%) | |
| Fishbain et al,25 USA | August–November 2000 | Prospective surveillance | 5% sheep agar and MRSA screen agar | Adults on admission, swabs within 48 hours from both nares and both axilla | 535 | 20/535 (3.7%) | 18/20 (90%) | 5/20 (25%) | Similar sensitivity but combined samples increasing negative predictive value | Nasal/axillary (100%) | |
| Lucet et al,26 France | July 1997–December 1997 | Prospective multicenter | Various media according to center | Adults in ICU swabs within 24 hours admission from nose and skin (both axilla and groin) | 2,347 | 162/2,347 (6.9%) | 126/162 (77.8%) | 72/162 (44.4%) | 19/162 (7.2%) | Nasal/skin 148/162 (92%) | |
| Papia et al,27 Canada | May 1996–May 1997 | Case control | Mannitol agar | Swabs from adults in acute care ward from different sites | 1,742 | 23/1,742 (1.3%) | 15/23 (65.2%) | 13/23 (56.5%) | 6/23 (26.1%) | Nasal/wound (91.3%) | Nasal/wound/perineum (95.7%) |
| Lautenbach et al,28 USA | January 2008–May 2008 | Cross-section | ChromAgar | Swabs on admission by research nurse and self on admission from different sites | 56 | Not stated | 46/55 (84%) | 48/55 (87%) | 3/55 (5.5%) | Nares/throat 50/55 (91%) | Nares/throat/groin (98%) |
| Senn et al,29 USA | 2006–2009 | Retrospective | M-Staphylococcus and MRSA-select agar | Swabs from different anatomic sites on admission for culture and PCR on adults | 12,456 | 3,137/12,456 (25.2%) | 1,509/3,137 (48%) | 1,628/3,137 (51.9%) | 1,320/3,137 (42.1%) | Groin/throat (89%) | Nose/groin/throat (96%) |
| Bitterman et al,30 Israel | 2003–2006 | Retrospective | BBL CHROMagar MRSA | Swabs from sites from ICU and non-ICU patients from screening sample (SS) and clinical diagnostic sample (CDS) | Not stated | 359 | 243/359 (67.7%) | 117/359 (32.3%) | 80/359 (22.2%) | Nares/perineum (89.6%) | Nares/perineum/throat (93.6%) |
Abbreviations: OX, Ofloxacin; FOX, cefoxitin; MRSA, methicillin-resistant Staphylococcus aureus; TID, theoretical isolation days; ICU, intensive care unit; HA, hospital associated; SSTI, skin and soft tissue infection; MICU, medical ICU; PCR, polymerase chain reaction.