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	In 2005 you were asked when should a patient treated for MRSA be recultured to determine if treatment was successful. Has that answer changed in 2006 and does it apply to CA MRSA?................ Answer in 2005! The answer to this question seems to have changed relatively recently. In the past, most would recommend performing 3 cultures, each one week apart after the end of treatment for infection or colonization and requiring that all three cultures be negative before determining that a patient was free of MRSA. However, the current table for isolation practices on the CDC web site, last reviewed April 1, 2005, indicates that for any multidrug-resistant organism, including MRSA, that a culture can be taken from any prior positive site (for example, nares if that was the only prior positive site) as soon as the treatment for infection and/or colonization is complete, and if that culture is negative then isolation can be discontinued. Our infection control committee has recently adopted that position, and our practice will be to perform a PCR test on any patient who has been nasally colonized with MRSA and undergone decolonization. If that test is negative they will be taken out of MRSA (Contact) isolation. The web address for the isolation practice guideline is: http://www.cdc.gov/doc.do/id/0900f3ec8021ee7a/ (General Listings); http://www.cdc.gov/ncidod/hip/isolat/isoapp_a.htm (Appendix A Table). (answered 03/15/2007)
	Yesterday a sales rep told me that a recent national meeting, they were informed that by 2008 direct specimen MRSA testing was to be performed on ALL hospital admissions. Does anyone know if this is true and can references be sited? Also, would anterior nares cultures plated directly to chrome agar or oxacillin agar with or without an enrichment broth be sufficient to achive this? One side question i thought we had resolved long ago, but after reading through some of these questions an answers i am not so sure; If one is using the Vitek I with the expert system, is in mandatory that all staphylococcus aureus isolates be subcultured to oxacillin agar? What about CoNS? Thanks. Leann Lawrence MT (answered 03/15/2007)
	Can you direct me to procedure for doing VRE screening on stool specimens? I have the CDC 1999 publication which says there are many ways to do it and gives the example of bile esculin azide agar + 6 ug/ml vanco. Is that still the best method? (answered 02/05/2007)
	Related to my question from yesterday - if BEA agar with 8 mcg/ml vanco is used to screen for VRE, should EACH black colony that grows be subbed for MICs? Seems like a lot of work, but I don't think one could assume that they are all the same. Would it be reasonable to screen the subs for motility and pigment and do MICs on all non-motile, non-pigmented? (answered 02/05/2007)
	Do patients with an ESBL become colonized? If so, where? thank you (answered 11/08/2006)
	how long to repeat MRSA screening in carriers who received treatment (answered 08/28/2006)
	Does any one know of a protocol for performing surveillance cultures on rectal swabs to r/o MDR Acinetobacter sp. (answered 08/19/2006)
	How long do we keep on screening patients with MRSA or VRE history? (answered 06/08/2006)
	We have been seeing Coag Positive Staph on our group B prenatal screens. We have been working them up and reporting them, some have been MRSA, this however is confusing some Doctors, are the patients carriers, should they be treated? (answered 06/02/2006)
	What is the temperature of incubation for primary MSA plates and Salt peptonr water for MRSA carrier detection? Which is the most suitable medium for MRSA isolation? Can I get a procedure protocol for MRSA carrier detection. (answered 05/19/2006)
	What is the protocol for testing patients who occupy the same room as a patient who is ESBL positive? If the patient is ESBL positive in their sputum, what cultures should be obtained from the patients who occupy the same room? It would be greatly appreciated if there are some articles I can refer our Infection Control nurse to. Thanks for the help. (answered 05/19/2006)
	Does a lab need specific certification to performing test for Legionella pneumophila? (answered 02/27/2006)
	WE ARE SCREENING STOOLS FOR VRE ON PATIENTS WHO WERE PREVIOUSLY POSITIVE FOR VRE. I SUGESTED USING CAMPY/CVA AGAR FOR THE INITIAL SCREEN. I LATER LEARNED CAMPY/CVA HAS 10 MG OF VANCOMYCIN AND THE BHI W/VANCOMYCIN HAS 6 MG OF VANCOMYCIN. THIS MEANS WE WILL BE MISSING VRE 'S AT THE 6MG AND 8MG RANGE. IS THIS SIGNIFICANT ? CAN WE STILL USE CAMPY/CVA PLATE? I HEARD OF OTHER HOSPITALS THAT USE THIS. WHAT IS YOUR SUGGESTION? (answered 01/27/2006)
	As a followup on previously diagnosed MRSA patients, we accept requests for "MRSA SCREEN" on recommended specimens such as nares, surgical wounds, various skin sites such as decubiti, and even sputum. We also get orders for "MRSA SCREEN" on other specimens such as blood, urine and stool specimens on those patients. These we consider to be inappropriate specimens for processing only for the detection of MRSA. When those requests are received, we consult with the submitting organization (most often a nursing home) and edit the order to a routine culture for that source,adding a screening plate to the set up. Is this appropriate or should we simply culture only for MRSA as requested and disregard other growth? Thank you for your help. (answered 01/17/2006)
	Can we use MRSA Chromagar plates for swabs other than nasal to detect MRSA as early as possible? I thought they were only approved for nasal swabs, but we frequently receive nasal + skin swabs for culture, specifically looking for MRSA. As long as we follow up with complete ID and susceptibilities, can we report a presumptive MRSA by Chromagar alone from a skin swab? Thank you. (answered 11/14/2005)
	What is the best methodology for MRSA screening of nasal swab cultures in hospitals? Which selective media is best in terms of sensitivity and turnaround time? We are trying to minimize tech time and maximize yield of screening specimens. (answered 10/31/2005)
	I am doing a small research project for school. I am testing for MRSA to compare the frequencies of MRSA in common ordinary people against the frequency of MRSA in hospital employees who are exposed more by direct contact to MRSA. I am looking at swabbing the nares and culturing on Mannitol Salt Agar. I think then I will use an oxacillin disk to test for oxacillin resistant MRSA. My questions are where exactly is the best place to swab the nares for MRSA (how far up)? Also would just using Mannitol Salt Agar and then use and oxacillin disk be a good way to detect for MRSA. I am wondering what other tests could be used, being this is just a small research project in a small university. What other test such as coagulase or other media and antibiotics would you suggest? (answered 10/31/2005)
	when a patient is treated for mrsa infection or colonization, when should you reculture to determine if treatment was successfull? (answered 10/31/2005)
	We perform MRSA screening with MRSA chromogenic plates from Biorad. We use one plate for each sample (nose, perineum,throat,...). Can we inoculate a mix sample from the same patiënt on one plate (Inoculate nose, perineum an throat over each other on one plate)? (answered 08/14/2005)
	I have been asked to perform environmental cultures on surfaces. Is there a reference that I can use? I also need info on Rodac media. (answered 07/22/2005)
	Is fumigation of operation theater and wards recommended? If so, what is the procedure for fumigation. (answered 07/20/2005)
	We had had 3 multi-resistant Acinetobactes in our chronic care facility and our ID MD has requested we screen these for ESBL's but the CLSI method refers only to Ecoli, the Klebs, and P.mirabilis. (These orgs have also been imipenem resistant.) Should we be doing additional testing on them to screen for resistance, and if so what? He is interested more from an infection control standpoint as they are trying to develop guidelines for patients with ESBL orgs in our facilities. (answered 06/21/2005)
	If a sputum culture is done to test for MRSA, how long does it take to get the results from that culture? (answered 06/21/2005)
	I need a procedure for MRSA screening. We had a baby with MRSA in the blood. we had to screen all 10 babies in the NICU x 3 sites and are in the process of screening 50 employee's noses. I can not get any one good way that people are doing this. (answered 06/03/2005)
	A policy in our hospital is to apply isolation and contact precautions to patients colonized or infected with ESBL -producing Enterobacteriacea. They remain in isolation till a discharge from the hospital. On subsequent admission(s), known positive patients are screened and isolated again. If the patient subsequently becomes culture negative for ESBL producers, WHEN can we consider the patient to be "cleared", remove the ESBL alert, and manage the patient using standard precautions? I could not find in the literature any clear and evidence based recommendations regarding the time and conditions required for ESBL clearance. I would appreciate your advice. Thank you. (answered 05/26/2005)
	Prevalence of acquiring MRSA from public restrooms (answered 01/11/2005)
	Can patient's with ESBL shared the same hospital room? (answered 09/18/2004)
	Do you have guidelines for dealing with environmental cultures. We get culture swabs from Physical Therapy testing water sterility in their various baths, and Pharmacy has just started sending plates testing for air sterility in their hoods and bench surface. I haven't been able to find approved procedures for these samples. (answered 09/16/2004)
	Could you please tell me what are the different reasons that swabs are taken during a mrsa outbreak. (answered 09/13/2004)
	I have to develop a procedure for screening for VRE, ESBLs,and multi-resistant gram negative organisms (MRGNO). I could not find any evidences in the literature what could be the best site(s) for screening. Are there any data confirming that rectal swab or feces are superior specimens for screening for VRE, ESBLs, and MRGNO than groin or perineal swabs? Can either of those four specimens be equally used for screening? Thanks for your time. (answered 07/20/2004)
	We are an OB/GYN hospital and screen all OB's in the 3rd trimester for GBS. Our ID phys has just asked that we screen these patients for MRSA as well. We do not have a surveillance program as of yet, so I am not very familiar with the different medias & methods that can be utilized. For our GBS screens, we inoculate a BAP and a LIM broth with the specimen. After incubation, we sub-culture the LIM to BAP and reincubate. Would you just look for Saur from the BAP, do a staph latex and inoculate Ox screen agar? Would you add any additional media (plate or broth)? We have MicroScan, should I do complete ID/MICs? Can I only bill for a MRSA screen if I add additional media? Can we bill for the Ox agar screen? (answered 07/20/2004)
	What about re-admission with previous hx of MRSA, do you culture and is there a standard to this effect. (answered 06/22/2004)
	We had an increase in nosocomial C. difficile infections at our hospital last year. Our infectious disease officer wants incoming patients who have a hx of C. diff to be isolated until they test negative ( we test using Premier Toxin A/B). He also wants patients who have had VRE isolated upon admission. He does not feel it necessary to isolate patients with a history of MRSA. I would like know what policies other community hospitals have regarding isolation for patients who have a hx of any of these pathogens. I think it would make more sense to isolate new admits with a hx of VRE and MRSA. Thanks for your insight. (answered 06/10/2004)
	Do you think it is useful to define the nasal carriage for MRSA in the community?  Would it be useful to know the prevalence of nasal carriage of MRSA in the community? (answered 04/26/2004)
	In bacterial infection sometimes the use of antibiotics can prolong the carrier stage after recovery. Why does it occur? (answered 03/24/2004)
	Why is Rifampin preferred for prophylaxis in bacterial diseases? (answered 03/23/2004)
	We screen rectal specimens for VRE at our hospital. Besides Enterococcus faecalis and E. faecium should we consider any other species from these specimens significant if they show vancomycin resistance? This would not include E. gallinarum, E. cassiflavus/E.flavescens which are intrinsically resistant.  (answered 03/11/2003)
	We are presently conducting a study which looks, in part, at the effect of antibiotics on bowel colonization with VRE. Many similar studies are published but most do not state whether strains were speciated and whether they included all VRE (particularly non pathogenic species). In such studies do you think it is important to speciate the VRE and consider E. faecium (and E. faecalis) separately from less pathogenic species? (answered 02/20/2003)
	I need to get statistics relating to the most common microorganisms associated with nosocomial infections with a % incidence - where can I find such information? (answered 10/24/2002)

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