Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital - 23/05/12
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Abstract |
Background |
Screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective.
Objective |
Our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects.
Methods |
A prospective, nonrandomized observational study of screening nonrisk patients ≤72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups.
Results |
A total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ≤ .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001).
Conclusion |
Screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients.
Le texte complet de cet article est disponible en PDF.Key Words : Admission screening, Universal MRSA screening, Infection control, MRSA epidemiology, MRSA screening costs
Plan
Supported by the Health Research Board, Ireland (TRA/2006/4). |
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Conflicts of interest: None to report. |
Vol 40 - N° 5
P. 411-415 - juin 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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