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Screening for MRSA Does Not Limit New Infections

Screening all surgical admissions had little effect in a European hospital with a relatively low infection rate.

Faced with soaring rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections, some experts recommend universal screening of all newly admitted hospital patients for MRSA carriage. In a giant prospective cohort crossover study that involved eight surgical services at a large Swiss teaching hospital, researchers evaluated the efficacy of this technique. During one 9-month period, each service screened all newly admitted patients for MRSA carriage; a second 9-month period provided control data. Throughout the study, MRSA carriers were treated with contact isolation, topical decolonization, and MRSA-directed emendation of the usual antibiotic protocols.

More than 10,000 patients were screened with rapid PCR-based analyses of swabs from nares, perineum, and other clinically indicated sites. Screening identified 515 MRSA carriers; most were not previously known to be colonized. However, screening made no difference in overall nosocomial MRSA infection rates nor in rates in any individual surgical service or in sites of infection. More than half of the 93 patients who acquired nosocomial MRSA infections during the screening periods had negative screens for MRSA on admission.

Comment: At 0.36 cases per 10,000 patient-days, this hospital’s rate of nosocomial MRSA infection is considerably lower than that of many other European and U.S. hospitals, and these results might not apply to hospitals with higher rates or to those in the midst of MRSA outbreaks. Still, editorialists remind us that MRSA, now germ-of-the-moment in the press, actually causes fewer than 10% of hospital-acquired infections in the U.S. and that more broadly directed infection-control interventions generally should be preferred over those directed against a single organism.

— Abigail Zuger, MD

Published in Journal Watch General Medicine March 11, 2008

Citation(s):

Harbarth S et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008 Mar 12; 299:1149.

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Diekema DJ and Climo M. Preventing MRSA infections. JAMA 2008 Mar 12; 299:1190.

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