Are Screening Nasal Swabs To Detect MRSA Clinically Useful In Predicting Outcomes In Adult Burn Centers: A Large Regional Burn Center’s Experience

Author(s):
Shawn Tejiram, 1,2; Laura Johnson, 1,2; Brittany Hamilton, 2; Kimberly Johnson, 2; Jenny Zhang, 2; Lauren Moffatt, 2; Jeffrey Shupp, 1 The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, 2 Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC

Background:

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant nosocomial pathogen known to be present in wounds, leading to delayed wound healing, scar formation, sepsis, and even death. The incidence of community acquired MRSA has risen over the past decade. This has prompted swab based nasal screening on admission to identify asymptomatic carriers.

Hypothesis:

The aim of this study was to determine if screening nasal swabs for MRSA upon admission to a major urban burn center would affect outcomes or patient management.

Methods:

A retrospective review was conducted on all burn injured patients who presented to a regional burn center between June 1, 2012 and June 30, 2014. Hospital electronic medical records and scanned charts were reviewed for patient demographics, clinical management, and bacterial culture testing. Patients who did not have a nasal swab or bacterial wound culture within 48 hours of admission were excluded. Identified MRSA positive patients were then subcategorized as early or late based on organism identification less than 48 hours after admission or afterward, respectively. Length of stay analysis was then done after normalizing to percent total body surface area burn (% TBSA).

Results:

799 patients met initial criteria. In this population, 54 (6.7% incidence) patients screened positive for MRSA during their hospital course. Patients who stayed greater than 48 hours had a length of stay of 4.64 days per % TBSA. Of these, 30 patients were identified with early MRSA compared to 21 patients with late MRSA diagnoses. The mean length of stay was 3.53 days in early MRSA patients compared to 6.09 days in late MRSA patients; this was not statistically significant.

Conclusions:

Burn injured patients who stay in the hospital greater than 48 hours and are diagnosed with MRSA at any point in their hospital stay have longer lengths of stay than published norms in the burn population (1 day per 1% TBSA). The early identification of patients who are colonized with MRSA might allow for modifications in their treatment and surgery in order to improve their outcomes. More work is underway to identify causal relationships between colonization and infectious complications.