Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital

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• 作者：Eilish Creamer ; MSc^a ; ^{eilishcreamer@rcsi.ie} ; 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&rsquo ; Lorcain ; PhD^f ; Robert Cunney ; MD^f ; ^g ; David C. Coleman ; PhD^e ; Hilary Humphreys ; MD^a ; ^d
• 关键词：Admission screening ; Universal MRSA screening ; Infection control ; MRSA epidemiology ; MRSA screening costs
• 刊名：American Journal of Infection Control
• 出版年：2012
• 期刊代码：9_01966553
• 类别：med
• 出版时间：June, 2012
• 卷：40
• 期：5
• 页码：411-415
• 文件大小：144 K

摘要

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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 鈮?2 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 鈮?.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.