Universal Screening for MRSA in Hospitals Made Little Difference
TUESDAY March 11, 2008 -- Universal screening for a common antibiotic-resistant bacteria is no better than standard infection control at reducing the rate of hospital-acquired infections in surgical patients, new Swiss research shows.
The bacteria, methicillin-resistant Staphylococcus aureus (MRSA), is an increasing public health concern.
But there is still hope, said study author Dr. Stephan Harbarth, attending physician in infectious diseases and associate hospital epidemiologist at University of Geneva Hospitals and Medical School in Geneva, noting that there has been an "unprecedented" decline of MRSA rates in several European countries and a stable, relatively low rate in others.
"Clearly, these recent findings suggest that MRSA spread can be curbed in hospitals, provided that active control programs are implemented," he continued. "For instance, following the introduction of specific programs for limiting cross-transmission, first at regional level and subsequently at national level, MRSA infection rates decreased by almost 50 percent between 1993 and 2006 in hospitals of the Paris region, and by 20 percent since 2001 in more than 50 hospitals across France."
Still, Harbarth cautioned, "this needs strong public health action, something not to be expected under the current federal administration of the U.S."
The findings are in the March 12 issue of the Journal of the American Medical Association.
Hospital-acquired and community-acquired MRSA infections have become a major public health challenge. The bacterium can lead to skin and blood infections and pneumonia.
According to a related editorial in the same issue of the journal, one-quarter of U.S. hospitals reported at least one MRSA outbreak in the prior year. And an estimated 18,000 or more deaths could be attributable to invasive MRSA infections in the United States in 2005. More than 4 million individuals in the United States may be carriers of the pathogen, and as many as 1.2 million U.S. hospital patients may be infected each year with MRSA.
Although medical experts and policymakers have called for universal screening at hospitals, no trial has looked into the matter.
This study, conducted between July 2004 and May 2006, involved 21,754 surgical patients at a Swiss teaching hospital. Researchers compared two control strategies for MRSA: rapid screening upon hospital admission plus standard infection control measures versus standard infection control measures only.
Patients on 12 surgical wards with different specialties were assigned to one group for nine months then switched to the other for another nine months.
The rate of surgical-site infections and hospital-acquired infections did not differ drastically between the two groups. The authors estimated that 30 patients would have to be screened at admission to detect one previously unidentified MRSA carrier.
One future option might be to target screening to surgical patients undergoing elective procedures with a higher risk of MRSA infection, the authors stated.
The study raises another important issue about the distinction between community-acquired and hospital-acquired infection, and whether universal screening might be more effective in the future.
"If you do screening on admission in the future, will it start to make a difference to MRSA transmission in the medical setting if the distinction continues to break down?" asked Philip Alcabes, an associate professor of urban public health at Hunter College School of Health Sciences in New York City. "That remains a question worth asking."
And existing procedures are nothing to scoff at in terms of effectiveness. "Standard infection control procedures do seem to work," said Alcabes. "It's a good idea, and that, in some ways, may be the most fundamental message. Don't forget routine infection control."
The U.S. Centers for Disease Control and Prevention has more on MRSA.
Posted: March 2008
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