David A. Pegues, MD
Does a rapid-screening test for methicillin-resistant Staphylococcus aureus (MRSA) reduce MRSA acquisition in hospital more than conventional screening?
Cluster-randomized, controlled, crossover trial.
Unclear allocation concealment.*
Up to 48 hours after discharge.
10 general wards in a hospital in London, England, UK.
8971 patients (median age 59 y, 59% men) who had specimens (swabs from nares, axillae, groin, and clinical sites) taken within 48 hours of ward admission.
Rapid screening (plus culture to confirm MRSA positivity) (5 wards) or conventional screening culture (5 wards) for 5 months. After a washout period, the wards switched to the alternate screening method for 5 months. Rapid screening, using a polymerase chain reaction (PCR) test, produces a result for MRSA in < 2 hours. Conventional culture produces a positive result for MRSA after ≥ 72 hours and a negative result after 24 hours. Standard MRSA control policies were followed in both groups.
MRSA acquisition (patients who had negative MRSA cultures at admission and developed positive MRSA cultures on screens or clinical specimens taken > 48 h after admission and ≤ 48 h after discharge), results turnaround time, and days of inappropriate isolation or nonisolation.
82% of patients with negative MRSA cultures at admission.
6.7% of patients had positive MRSA cultures at admission. Groups did not differ for MRSA acquisition rate (Table). Time from admission to reporting of MRSA screening results was shorter in the rapid-screening group (22 vs 46 h, P < 0.001). MRSA-negative patients were inappropriately isolated for 277 days in the rapid-screening group compared with 399 days in the culture-screening group (P < 0.001); inappropriate nonisolation of MRSA-positive patients was 351 and 389 days, respectively (P = 0.08).
Rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) did not reduce MRSA acquisition in hospital.
Rapid vs conventional screening to prevent methicillin-resistant Staphylococcus aureus (MRSA) acquisition in hospital†
†NS = not significant; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from odds ratio in article adjusted for age, sex, American Society of Anesthesiology score, length of stay, and ward features.
David A. Pegues. Rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) did not reduce MRSA acquisition rate. Ann Intern Med. 2008;149:JC2–14. doi: 10.7326/0003-4819-149-4-200808190-02014
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Published: Ann Intern Med. 2008;149(4):JC2-14.
Infectious Disease, MRSA, Prevention/Screening.
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