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    Screening For Resistant Organisms

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    tanty_uk
    This document discusses screening for resistant organisms in healthcare settings. It describes both passive and active surveillance approaches, with active screening being more effective but requiring more resources. The document recommends screening for organisms like MRSA, VRE, and carbapenem-resistant Enterobacteriaceae due to the risks they pose. Both culture-based and PCR-based methods are outlined for detecting different organisms from various body sites like the nose, stool, or wounds. Considerations for screening include the target population, organisms of interest, testing methodologies, sampling sites, duration, and ability to intervene if organisms are found.

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    Screening For Resistant Organisms

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    tanty_uk
    39 views39 pages
    This document discusses screening for resistant organisms in healthcare settings. It describes both passive and active surveillance approaches, with active screening being more effective but requiring more resources. The document recommends screening for organisms like MRSA, VRE, and carbapenem-resistant Enterobacteriaceae due to the risks they pose. Both culture-based and PCR-based methods are outlined for detecting different organisms from various body sites like the nose, stool, or wounds. Considerations for screening include the target population, organisms of interest, testing methodologies, sampling sites, duration, and ability to intervene if organisms are found.

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    Methods to screen for resistant organisms

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    Screening for Resistant Organisms

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    This document discusses screening for resistant organisms in healthcare settings. It describes both passive and active surveillance approaches, with active screening being more effective but requiring more resources. The document recommends screening for organisms like MRSA, VRE, and carbapenem-resistant Enterobacteriaceae due to the risks they pose. Both culture-based and PCR-based methods are outlined for detecting different organisms from various body sites like the nose, stool, or wounds. Considerations for screening include the target population, organisms of interest, testing methodologies, sampling sites, duration, and ability to intervene if organisms are found.

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    39 views39 pages

    Screening For Resistant Organisms

    Uploaded by

    tanty_uk
    This document discusses screening for resistant organisms in healthcare settings. It describes both passive and active surveillance approaches, with active screening being more effective but requiring more resources. The document recommends screening for organisms like MRSA, VRE, and carbapenem-resistant Enterobacteriaceae due to the risks they pose. Both culture-based and PCR-based methods are outlined for detecting different organisms from various body sites like the nose, stool, or wounds. Considerations for screening include the target population, organisms of interest, testing methodologies, sampling sites, duration, and ability to intervene if organisms are found.

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    Screening for Resistant Organisms

    Dr Koh Tse Hsien Singapore General Hospital

    How do you detect resistant organisms?


    Passive surveillance
    Normal lab results No extra work or cost May only pick up tip of the iceberg (20%)

    Active surveillance
    Screening Picks up colonization Extra work and cost

    Why screen?
    There is a problem
    resistant bacteria affects patient morbidity and mortality infections with resistant bacteria increase costs

    There is an intervention
    isolation of patient clearance of carriage empirical treatment

    What to screen
    Vancomycin-resistant Enterococcus (VRE) Methicillin-resistant Staphylococcus aureus (MRSA) Extended-spectrum cephalosporin resistant Enterobacteriaceae Carbapenemase-producing Enterobacteriaceae (CPE) etc..

    How to screen
    Culture
    Selective agar

    Non-culture
    PCR

    Selective agars
    Antibiotic content allows selection of resistance phenotype Chromogenic indicator may allow presumptive identification Takes at least 24 hours Enrichment broth step? Labor intensive Allows isolation of strain for typing studies

    PCR
    May be more sensitive Faster time to result May be technically complex Expensive

    MRSA
    Pooled nose, axilla, (throat), and perineal swab

    http://www.bd.com/ds/productCenter/215084.asp http://www.bio-rad.com/

    Enrichment or no enrichment?
    Adding MRSA broth (ThermoScientific) increased detection by 50% in SGH samples But adds one extra days incubation to confirm positive

    http://www.rapidmicrobiology.com/news/603h120p.JPG

    PCR

    http://www.bd.com/geneohm/english/products/max/instrument/ http://www.cepheid.com/tests-and-reagents/clinical-ivd-test/xpert-mrsa http://www.roche.com/products/product-details.htm?type=product&id=109

    http://www.cepheidondemand.com/Summer-2011/cover-story.php

    FIG. 2. Hypothetical virulence factors in USA300 and other CA-MRSA strains

    David, M. Z. et al. 2010. Clin. Microbiol. Rev. 23(3):616-687

    VRE
    Stool or rectal swab

    Vitek II

    Magnapure

    Qiagen DNA minikit

    CPE
    Stool or rectal swab

    5ml TSB+Meropenem disk

    Meropenem 10 g disk

    MacConkey Agar with Imipenem Disk


    Imipenem

    Chromagar KPC

    ChromID ESBL

    Cefpodoxime

    MAST Adatabs

    MacConkey +Meropenem 1 mg/L

    ChromID CARBA

    Direct from stool

    Questions to ask yourself before starting surveillance


    What is the target population? Which resistant organisms do you want to identify? Which method? What body sites to sample? How long are you going to survey? Admission surveillance or periodic surveillance? Who pays? Is there will and money to intervene?
    Modified from Best Practices in MDRO Screening and Control by Richard A van Enck

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