To screen or not to screen for methicillin-resistant Staphylococcus aureus

NorthShore University HealthSystem, Department of Laboratory Medicine and Pathology, 2650 Ridge Avenue, Walgreen Bldg., SB525, Evanston, IL 60201, USA.
Journal of clinical microbiology (Impact Factor: 3.99). 03/2010; 48(3):683-9. DOI: 10.1128/JCM.02516-09
Source: PubMed


There are few more compelling questions in clinical microbiology today than the issue of whether or not to screen for the presence of methicillin-resistant Staphylococcus aureus (MRSA), with the results being used to institute infection control interventions aimed at preventing transmission of MRSA in health care environments. Numerous different matters must be addressed when considering a screening program. Who is to be screened, what method is to be employed to detect MRSA, and what sites should be sampled? When and how often should the screening be performed? Who is going to pay for the screening, and, finally and perhaps most importantly, how are screening results to be communicated to health care providers and what kind of interventions are best undertaken based on the results? Numerous governmental agencies have mandated MRSA screening programs, and yet several authorities in infection control organizations have questioned the appropriateness of mandated screening. In this Point-Counterpoint feature, Dr. Lance Peterson of Evanston Hospital (Evanston, IL) offers his perspective on why screening for MRSA is to be encouraged. Dr. Daniel Diekema of the University of Iowa Carver College of Medicine (Iowa City, IA) offers an opposing view.

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Available from: Lance R Peterson, Oct 08, 2014
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    • "Although several epidemiological studies have provided information on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in different hospital settings [2-4] and in emergency department personnel [5,6], limited data exist on MRSA colonization rates for patients seen in emergency departments. The cost benefit of screening for MRSA colonization is not overwhelming and the subject is controversial [7]. A limitation of both culture-based and molecular methods of MRSA screening is that current tests determine only the presence or absence of colonization with no information on the colonizing strain type [8]. "
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    ABSTRACT: A limitation of both culture-based and molecular methods of screening for staphylococcal infection is that current tests determine only the presence or absence of colonization with no information on the colonizing strain type. A technique that couples polymerase chain reaction to mass spectrometry (PCR/ESI-MS) has recently been developed and an assay validated to identify and genotype S. aureus and coagulase-negative staphylococci (CoNS). This study was conducted to determine the rates, risk factors, and molecular genotypes of colonizing Staphylococcus aureus in adult patients presenting to an inner-city academic emergency department. Participants completed a structured questionnaire to assess hospital and community risks for infection with methicillin-resistant S. aureus (MRSA). Nasal swabs were analyzed by PCR/ESI-MS to identify and genotype S. aureus and CoNS. Of 200 patients evaluated, 59 were colonized with S. aureus; 27 of these were methicillin-resistant strains. Twenty-four of the 59 S. aureus carriers were co-colonized with a CoNS and 140 of the 200 patients were colonized exclusively with CoNS. The molecular genotypes of the 59 S. aureus strains were diverse; 21 unique molecular genotypes belonging to seven major clonal complexes were identified. Eighty-five of 200 patients carried strains with high-level mupirocin resistance. Of these eighty-five participants, 4 were colonized exclusively with S. aureus, 16 were co-colonized with S. aureus and CoNS, and 65 were colonized exclusively with CoNS). The prevalence of S. aureus and methicillin-resistant S. aureus colonization in a random sample of patients seeking care in Emergency Department was 29.5% and 13.5%, respectively. A substantial fraction of the S. aureus-colonized patients were co-colonized with CoNS and high-level mupirocin-resistant CoNS. Determining the molecular genotype of S. aureus during intake screening may prove valuable in the future if certain molecular genotypes become associated with increased infection risk.
    BMC Infectious Diseases 01/2014; 14(1):16. DOI:10.1186/1471-2334-14-16 · 2.61 Impact Factor
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    • "Keywords infection prevention methicillin-resistant Staphylococcus aureus MRSA patient safety successfully in the Netherlands and other Scandinavian countries for over a decade (Verhoef et al., 1999; Vos et al., 2009), the effectiveness of this strategy for reducing MRSA infections in the United States is not without controversy (Peterson & Diekema, 2010). The effect of universal ASC at admission on MRSA infections has varied between studies (Harbarth et al., 2008; Huskins et al., 2011; Jain et al., 2011; Robicsek et al., 2008), and reductions in hospital-acquired infections have been observed in the absence of ASC (Edmond, Ober, & Bearman, 2008). "
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.
    Journal for Healthcare Quality 05/2013; 35(3):57-69. DOI:10.1111/jhq.12008 · 1.40 Impact Factor
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    • "Controversy exists about the benefit of screening for preventing MRSA transmission in hospitals and the most effective methods and strategies for MRSA screening programs, and recent studies have shown conflicting results regarding the effect of MRSA screening and control interventions [6-10,17-20]. In the present study, we evaluated the MRSA IDs and influencing factors in 186 German ICUs with a focus on MRSA screening procedures. "
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    ABSTRACT: Controversy exists about the benefit of screening for prevention of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs) and recent studies have shown conflicting results. The aim of this observational study was to describe and evaluate the association between MRSA incidence densities (IDs) and screening and control measures in ICUs participating in the German Nosocomial Infection Surveillance System. The surveillance module for multidrug-resistant bacteria collects data on MRSA cases in ICUs with the aim to provide a national reference and a tool for evaluation of infection control management. The median IDs of MRSA cases per 1000 patient-days (pd) with the interquartile range (IQR) were calculated from the pooled data of 186 ICUs and correlated with parameters derived from a detailed questionnaire regarding ICU structure, microbiological diagnostics and MRSA screening and control measures. The association between questionnaire results and MRSA cases was evaluated by generalized linear regression models. One hundred eighty-six ICUs submitted data on MRSA cases for 2007 and 2008 and completed the questionnaire. During the period of analysis, 4935 MRSA cases occurred in these ICUs; of these, 3928 (79.6%) were imported and 1007 MRSA cases (20.4%) were ICU-acquired. Median MRSA IDs were 3.23 (IQR 1.24-5.73), 2.24 (IQR 0.63-4.30) and 0.64 (IQR 0.17-1.39) per 1000 pd for all cases, imported and ICU-acquired MRSA cases, respectively. MRSA IDs as well as implemented MRSA screening and control measures varied widely between ICUs. ICUs performing universal admission screening had significantly higher MRSA IDs than ICUs performing targeted or no screening. Separate regression models for ICUs with different screening strategies included the incidence of imported MRSA cases, the type of ICU, and the length of stay in independent association with the number of ICU-acquired MRSA cases. The analysis shows that MRSA IDs and structural parameters differ considerably between ICUs. In response, ICUs have combined screening and control measures in many ways to achieve various individual solutions. The incidence of imported MRSA cases might be helpful for consideration in the planning of MRSA control programmes.
    Critical care (London, England) 11/2011; 15(6):R285. DOI:10.1186/cc10571 · 4.48 Impact Factor
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