The Role of Patient History and Body Site Surveillance Cultures as Predictors of Colonization in a Long-Term Acute Care Hospital Setting.

BACKGROUND: Long-term acute care hospitals (LTACHs) have high rates of antibiotic and device use, hospital-acquired infections, and antibiotic resistance. Admission surveillance cultures are controversial. OBJECTIVE: Evaluate the significance of patienthistory and multiple body site admission surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN: Retrospective review of preadmission history and surveillance cultures from multiple body sites of 594 new admissions and cultures obtained for subsequent clinical status changes. RESULTS: Thirteen percent of patients were positive for MRSA and 16% for VRE on admission screening. Neither MRSA nor VRE history was predictive of colonization: 44% of patients with MRSA history screened MRSA positive; 48% with VRE history screened VRE positive. No single body site was predictive for MRSA or VRE colonization. CONCLUSION: Neither patient history nor a single body site was highly predictive of colonization; multisite surveillance may be optimal to evaluate MRSA and VRE burden.