4 years ago

MRSA Decolonization Control: Comparing a Single-day Swabbing Regimen with an Established Three-day Protocol

Success of MRSA decolonization procedures is usually verified by control swabs of the colonized body region. This prospective controlled study compared a single-day regimen with a well-established 3-day scheme for noninferiority and adherence to the testing scheme. Methods Two sampling schemes for screening MRSA patients of a single study cohort at a German tertiary hospital 2 days after decolonization were compared regarding their ability to identify MRSA colonization in throat or nose. In each patient, three nose and three throat swabs were taken at 3- to 4-hour intervals during screening day 1, and in the same patients once daily on days 1, 2, and 3. Swabs were analyzed using chromogenic agar and broth enrichment. The study aimed to investigate whether the single-day swabbing scheme is not inferior to the 3-day scheme with a 15%-noninferiority margin. Results 160 patients were included, comprising 105 and 101 patients with results on all three swabs for decolonization screening of the nose and throat, respectively. Noninferiority of the single-day swabbing scheme was confirmed for both pharyngeal and nasal swabs with 91.8% and 89% agreement, respectively. The absolute difference of positivity rates between the swabbing regimens was 0.025 (−0.082, 0.131) for the nose and 0.006 (−0.102, 0.114) for the pharynx as calculated with McNemar’s test for matched or paired data. Compliance with the single-day scheme was better, with 12% lacking second-day-swabs and 27% lacking third-day-swabs. Conclusions The better adherence to the single-day screening scheme with noninferiority suggests its implementation as the new gold standard.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304809

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