Cost-effectiveness of different MRSA screening methods

Kunori, Takeaki; Cookson, Barry; Roberts, Jenny; Stone, Sheldon; Kibbler, C

doi:10.1053/jhin.2002.1247

Cited by 57 publications

(30 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Screening high-risk patients and health care workers for MRSA is one of the control measures. Several studies have found that such screening programs are cost-effective (3,10,12,16).…”

Section: Discussionmentioning

confidence: 99%

Rapid Screening and Identification of Methicillin-Resistant Staphylococcus aureus from Clinical Samples by Selective-Broth and Real-Time PCR Assay

Fang¹,

Hedin²

2003

J Clin Microbiol

169

102

View full text Add to dashboard Cite

A screening method for methicillin-resistant Staphylococcus aureus (MRSA) by using selective broth and real-time PCR (broth-PCR) was developed and evaluated. The samples (n ‫؍‬ 304) were cultured in the broth overnight, followed by nuc gene detection by real-time PCR. nuc-negative samples were further checked for the presence of nuc amplification inhibitors by a PCR internal inhibitor assay. nuc-positive samples and nucnegative samples with PCR inhibitors were cultured onto plates and processed further. The diagnostic values for this MRSA screening method were 93.3% sensitivity, 89.6% specificity, 31.8% positive predictive value, and 99.6% negative predictive value. The application of the broth-PCR method will be able to report most of the negative samples (258 of 289 [89.3%]) on the next morning and can save as much as 84.9% (258 of 304) of the labor and cost spent on processing the nuc-negative specimens on plates. In the study, all the samples were processed in parallel by the broth enrichment method and the plating method for comparison. To identify MRSA, the isolated oxacillin-resistant S. aureus strains were tested by a duplex real-time PCR targeting the mecA gene and the nuc gene. A collection of MRSA, methicillin-susceptible Staphylococcus aureus, methicillinresistant Staphylococcus epidermidis, and methicillin-susceptible Staphylococcus epidermidis strains and a panel of standard strains of 11 bacterial species other than S. aureus were also tested by this method, which was proved to be a valuable tool for MRSA identification in a routine microbiological laboratory.Staphylococcus aureus is one of the most significant human pathogens, causing both nosocomial and community-acquired infections. Its main habitats are the nasal membranes and the skin of humans and warm-blooded animals. S. aureus can cause a range of infectious diseases from mild conditions, such as skin and soft tissue infections, to severe, life-threatening debilitation (14, 23). Strains of methicillin-resistant S. aureus (MRSA) were first detected in the early 1960s, shortly after methicillin came into clinical use. Resistance to methicillin is mediated by the presence of penicillin-binding protein 2a , encoded by the mecA gene (4). No available ␤-lactam binds effectively to PBP-2a, and staphylococci resistant to methicillin or oxacillin should be generally regarded as resistant to all ␤-lactams (13). Since the end of the 1970s, the occurrence of MRSA has increased steadily. Molecular epidemiological studies have shown that a limited number of MRSA strains have spread by clonal dissemination between different hospitals, cities, countries, and even continents and are now the cause of hospital infections worldwide (5, 15). MRSA strains are usually introduced into an institution by an infected or colonized patient or by a colonized health care worker. Thus, epidemiological surveys and control measures are particularly important for MRSA. Rapid screening followed by accurate and timely identification of MRSA becomes an elemental procedure in p...

show abstract

“…Screening high-risk patients and health care workers for MRSA is one of the control measures. Several studies have found that such screening programs are cost-effective (3,10,12,16).…”

Section: Discussionmentioning

confidence: 99%

Rapid Screening and Identification of Methicillin-Resistant Staphylococcus aureus from Clinical Samples by Selective-Broth and Real-Time PCR Assay

Fang¹,

Hedin²

2003

J Clin Microbiol

169

102

View full text Add to dashboard Cite

show abstract

“…For example, it may be a hospital's policy to screen all patients going into an intensive care unit [30] but not for other wards. Our simple average screening rate is inadequate to determine the impact that this selective screening may have on transmission dynamics.…”

Section: Limitations Of the Modelmentioning

confidence: 99%

Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA)

2006

View full text Add to dashboard Cite

SUMMARYWith reports of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) continuing to increase and therapeutic options decrease, infection control methods are of increasing importance. Here we investigate the relationship between surveillance and infection control. Surveillance plays two roles with respect to control : it allows detection of infected/colonized individuals necessary for their removal from the general population, and it allows quantification of control success. We develop a stochastic model of MRSA transmission dynamics exploring the effects of two screening strategies in an epidemic setting : random and on admission. We consider both hospital and community populations and include control and surveillance in a single framework. Random screening was more efficient at hospital surveillance and allowed nosocomial control, which also prevented epidemic behaviour in the community. Therefore, random screening was the more effective control strategy for both the hospital and community populations in this setting. Surveillance strategies have significant impact on both ascertainment of infection prevalence and its control.

show abstract

“…Resistance to ciprofloxacin has been identified as a surrogate marker for the detection of MRSA, and this agent has been used successfully to supplement Baird-Parker medium (7,17) and mannitol broth (11). These methods are limited, however, since they cannot detect ciprofloxacin-sensitive MRSA strains, which may occur in some areas (14).…”

mentioning

confidence: 99%

Development and Evaluation of a Chromogenic Agar Medium for Methicillin-Resistant Staphylococcus aureus

et al. 2004

View full text Add to dashboard Cite

We describe here the development and evaluation of MRSA ID, a new chromogenic agar medium for the specific isolation and identification of methicillin-resistant Staphylococcus aureus (MRSA). We used S. aureus ID (bioMérieux, La Balme Les Grottes, France) and supplemented it with various antimicrobials, including cefoxitin, ciprofloxacin, oxacillin, and methicillin. Cefoxitin proved to be superior to the other antimicrobials for the selection of MRSA from other strains of S. aureus. MRSA ID (consisting of S. aureus ID supplemented with 4 mg of cefoxitin/liter) was evaluated by the use of 747 swabs from various clinical sites. All specimens were also cultured on CHROMagar MRSA and oxacillin resistance screening agar base (ORSAB) and in selective mannitol broth (SMB). A total of 85 MRSA strains were isolated by a combination of all methods. After 22 to 24 h of incubation, 80% of the MRSA strains were isolated as green colonies on MRSA ID, compared with 59 and 62% of the strains that were isolated as colored colonies on CHROMagar MRSA and ORSAB, respectively. After 48 h of incubation, 89, 72, and 78% of the MRSA strains were isolated on MRSA ID, CHROMagar MRSA, and ORSAB, respectively. Sixty-five percent of the strains were isolated by growth in SMB. The specificities of MRSA ID, CHROMagar MRSA, ORSAB, and SMB were 99.5, 99.3, 97.9, and 92.8%, respectively, after 22 to 24 h of incubation. We conclude that MRSA ID is a sensitive and specific medium for the isolation and identification of MRSA.

show abstract

Cost-effectiveness of different MRSA screening methods

Cited by 57 publications

References 29 publications

Rapid Screening and Identification of Methicillin-Resistant Staphylococcus aureus from Clinical Samples by Selective-Broth and Real-Time PCR Assay

Rapid Screening and Identification of Methicillin-Resistant Staphylococcus aureus from Clinical Samples by Selective-Broth and Real-Time PCR Assay

Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA)

Development and Evaluation of a Chromogenic Agar Medium for Methicillin-Resistant Staphylococcus aureus

Contact Info

Product

Resources

About