Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital - 23/05/12
, Sandra Galvin, PhD a, Anthony Dolan, PhD a, Orla Sherlock, PhD a, Borislav D. Dimitrov, PhD b, Deirdre Fitzgerald-Hughes, PhD a, Toney Thomas, MBA c, John Walsh, BSc c, Joan Moore, FAMLS d, Edmond G. Smyth, MD d, Anna C. Shore, PhD e, Derek Sullivan, PhD e, Peter Kinnevey, PhD e, Piaras O’Lorcain, PhD f, Robert Cunney, MD f, g, David C. Coleman, PhD e, Hilary Humphreys, MD a, d
Address correspondence to Eilish Creamer, MSc, Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, PO Box 9063, Beaumont Road, Dublin 9, Ireland.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 numéro
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