SCREENING FOR MRSA/SA AND MGNB/ESBL/CPE

• SA= Meticillin-Sensitive Staphylococcus Aureus
• MRSA= Meticillin-resistant Staphylococcus aureus
• MGNB = Multi-drug resistant Gram-negative bacilli (GNB);
• includes GNB that are resistant to 3 classes of antimicrobials, e.g. piperacillin/tazobactam, gentamicin and ciprofloxacin
• ESBL = Extended Spectrum Beta-Lactamase-producing Gram-negative bacilli
• resistant to co-amoxiclav, piperacillin/tazobactam, and ceftriaxone
• may be resistant to other classes of antimicrobials
• but are sensitive to carbapenems
• CARB = Carbapenem-resistant Gram-negative bacilli;
• these GNB may be more multi-drug resistant than ESBL
• may be fully resistant to meropenem
• includes Multi-Drug Resistant Acinetobacter baumannii (MDRAB) that may be pan-resistant and CPE
• CPE = Carbapenemase-producing Enterobacteriaceae
• a subgroup of CARB
• include carbapenem-resistant Klebsiella pneumoniae, E. coli and Enterobacter cloaca;
• the common types of carbapenemase gene in CPE are: OXA-48, KPC, and NDM

Responsible person

• Appoint someone to check results and inform consultant if MRSA/SA/MGNB/ESBL/CPE detected

Consent

• Explain reason for taking swabs and obtain patient’s consent

Elective STAPH screen

Timing

• Note: If undergoing MRSA decolonisation or other antimicrobial treatment, delay screening until >48 hr after completion
• If patient at home, screen 2–4 weeks (maximum 8 weeks) before SA infection high-risk surgery
• If patient not at home and not in hospital, screen 7 days (6–8 days) before transfer/procedure and again on admission
• If patient in hospital, send samples for STAPH SCREEN 7 days before elective SA high-risk surgery

How

• Swab anterior nares, perineum, throat, and any skin lesion or ulcer
• if long-term catheterised, add CSU
• if productive cough, add sputum
• Tick STAPH SCREEN on microbiology request card

Elective MRSA screen

Timing

• If patient at home, screen 2–4 weeks (maximum 6 months) before elective admission
• If patient not at home and not in hospital, screen 7 days before transfer (include perineum swab) and again on admission
• If undergoing MRSA decolonisation or other antimicrobial treatment, delay screening until >48 hr after completion

How

• Swab anterior nares
• Swab any skin lesion or ulcer
• if long-term catheterised, add CSU
• if productive cough, add sputum
• Add swab from perineum:
• if patient tagged for MRSA on iPortal, or
• if patient is to be admitted to ‘MRSA screened patient’ area
• Tick MRSA SCREEN on request card

Screening for MRSA carriage on transfer or emergency admission

Timing

• Note: If undergoing MRSA decolonisation or other antimicrobial treatment, delay screening until >48 hr after completion
• Otherwise, immediate screen

How

• Swab anterior nares and perineum (swab from throat instead of perineum acceptable if consent for perineum swab cannot be obtained in acute admission area)
• Swab all ulcers and skin lesions
• if long-term catheterised, add CSU
• swab any IV line that is impractical to change and record VIP score 8-hrly
• if productive cough, add sputum
• Tick MRSA SCREEN on microbiology request
• if renal dialysis line in situ, request STAPH SCREEN instead

Screening for MGNB (includes screening for ESBL and CARB/CPE)

Timing

• Immediate

How

• Rectal swab (if stoma or unable to obtain rectal swab, send swab from stool sample)
• ensure that swab has visible faecal material
• if long-term catheterised, add CSU
• Tick MGNB SCREEN on microbiology request
• If a patient has been identified as a close contact of a patient with confirmed CPE by IP team, contact microbiology
• submit the Copan rectal/stool swab, with visible faecal material, requesting “CPE PCR test”