Hostname: page-component-55f67697df-twqc4 Total loading time: 0 Render date: 2025-05-09T12:11:36.172Z Has data issue: false hasContentIssue false
  • English
  • Français

Real-Time Polymerase Chain Reaction Detection of Methicillin-Resistant Staphylococcus aureus: Impact on Nosocomial Transmission and Costs

Published online by Cambridge University Press:  02 January 2015

L. O. Conterno ,
J. Shymanski ,
K. Ramotar ,
B. Toye ,
C. van Walraven ,
D. Coyle  and
V. R. Roth
L. O. Conterno
Affiliation:
Division of Infectious Diseases, Marilia Medical School, Marilia, Sao Paulo, Brazil
J. Shymanski
Affiliation:
Ottawa Hospital, Ottawa, Ontario
K. Ramotar
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario
B. Toye
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario
C. van Walraven
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
D. Coyle
Affiliation:
University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario
V. R. Roth*
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario
*
Division of Infectious Diseases, Ottawa Hospital, 510 Smyth Rd., Room G12, Ottawa, Ontario, CanadaK1H 8L6 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives.

To assess the impact of real-time polymerase chain reaction (PCR) detection of methicillin-resistant Staphylococcus aureus (MRSA) on nosocomial transmission and costs.

Design.

Monthly MRSA detection rates were measured from April 1, 2000, through December 31, 2005. Time series analysis was used to identify changes in MRSA detection rates, and decision analysis was used to compare the costs of detection by PCR and by culture.

Setting.

A 1,200-bed, tertiary care hospital in Canada.

Patients.

Admitted patients at high risk for MRSA colonization. MRSA detection using culture-based screening was compared with a commercial PCR assay.

Results.

The mean monthly incidence of nosocomial MRSA colonization or infection was 0.37 cases per 1,000 patient-days. The time-series model indicated an insignificant decrease of 0.14 cases per 1,000 patient-days per month (95% confidence interval, —0.18 to 0.46) after the introduction of PCR detection (P = .39). The mean interval from a reported positive result until contact precautions were initiated decreased from 3.8 to 1.6 days (P<.001). However, the cost of MRSA control increased from Can$605,034 to Can$771,609. Of 290 PCR-positive patients, 120 (41.4%) were placed under contact precautions unnecessarily because of low specificity of the PCR assay used in the study; these patients contributed 37% of the increased cost. The modeling study predicted that the cost per patient would be higher with detection by PCR (Can$96) than by culture (Can$67).

Conclusion.

Detection of MRSA by the PCR assay evaluated in this study was more costly than detection by culture for reducing MRSA transmission in our hospital. The cost benefit of screening by PCR varies according to incidences of MRSA colonization and infection, the predictive values of the assay used, and rates of compliance with infection control measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 10 , October 2007 , pp. 1134 - 1141
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42:389–391.Google Scholar
2. Surveillance for methicillin-resistant Staphylococcus aureus in Canadian hospitals: a report update from the Canadian Nosocomial Infection Surveillance Program. Can Commun Dis Rep 2005;31:33–40.Google Scholar
3. The second year of the Department of Health's mandatory MRSA bacteremia surveillance scheme in acute NHS trusts in England: April 2002-March 2003. Commun Dis Rep CDR Wkly 2003;13:1–9.Google Scholar
4. Gould, IM. The clinical significance of methicillin-resistant Staphylococcus aureus . J Hosp Infect 2005;61:277–282.Google Scholar
5. Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.Google Scholar
6. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
7. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
8. Lodise, TP, McKinnon, PS. Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2005;52:113–122.Google Scholar
9. McHugh, CG, Riley, LW. Risk factors and costs associated with methicillin-resistant Staphylococcus aureus bloodstream infections. Infect Control Hosp Epidemiol 2004;25:425–430.Google Scholar
10. Salgado, CD, Farr, BM. What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures? Infect Control Hosp Epidemiol 2006;27:116–121.Google Scholar
11. Coia, JE, Duckworth, GJ, Edwards, DI, et al. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(suppl 1):S1–S44.Google Scholar
12. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.Google Scholar
13. Kotilainen, P, Routamaa, M, Peltonen, R, et al. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001;161:859–863.Google Scholar
14. Kotilainen, P, Routamaa, M, Peltonen, R, et al. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003;9:169–175.Google Scholar
15. Pan, A, Carnevale, G, Catenazzi, P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA “search and isolate” strategy in a hospital in Italy with hyperendemic MRSA.Infect Control Hosp Epidemiol 2005;26:127–133.Google Scholar
16. West, TE, Guerry, C, Hiott, M, Morrow, N, Ward, K, Salgado, CD. Effect of targeted surveillance for control of methicillin-resistant Staphylococcus aureus in a community hospital system. Infect Control Hosp Epidemiol 2006;27:233–238.Google Scholar
17. Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.Google Scholar
18. Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188.Google Scholar
19. Papia, G, Louie, M, Tralla, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999;20:473–477.Google Scholar
20. Wernitz, MH, Swidsinski, S, Weist, K, et al. Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections. Clin Microbiol Infect 2005;11:457–465.Google Scholar
21. Huletsky, A, Giroux, R, Rossbach, V, et al. New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci. J Clin Microbiol 2004;42:1875–1884.Google Scholar
22. Ritchie, K, Bradbury, I, Eastgate, J. Consultation report on health technology: clinical and cost effectiveness of screening for MRSA. Scotland: NHS Quality Improvement;June 2006.Google Scholar
23. Raboud, J, Saskin, R, Simor, A, et al. Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 2005;26:607–615.Google Scholar
24. Bootsma, MC, Diekmann, O, Bonten, MJ. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci USA 2006;103:5620–5625.Google Scholar
25. Slinger, R, Lee, A, Martel, C, et al. Methicillin-resistant Staphylococcus aureus (MRSA) detection with brain heart infusion ceftizoxime and aztreonam broth (BHI-CA) and oxacillin resistance screening agar base (ORSAB). In: Program and abstracts of the 70th Annual Canadian Association of Clinical Microbiology and Infectious Diseases (CACMID) Conference (Halifax, Nova Scotia). 2002. Abstract D4.Google Scholar
26. Embil, J, Ramotar, K, Romance, L, et al. Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies 1990-1992. Infect Control Hosp Epidemiol 1994;15:646–651.Google Scholar
27. Desjardins, M, Guibord, C, Lalonde, B, Toye, B, Ramotar, K. Evaluation of the IDI-MRSA assay for detection of methicillin-resistant Staphylococcus aureus from nasal and rectal specimens pooled in a selective broth. J Clin Microbiol 2006;44:1219–1223.Google Scholar
28. Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99–104.Google Scholar
29. Struelens, MJ, Denis, O. Rapid molecular detection of methicillin-resistant Staphylococcus aureus: a cost-effective tool for infection control in critical care? Crit Care 2006;10:128.Google Scholar
30. Harbarth, S, Masuet-Aumatell, C, Schrenzel, J, et al. Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006;10:R25.Google Scholar
31. Louie, L, Soares, D, Meaney, H, Vearncombe, M, Simor, AE. Evaluation of a new chromogenic medium, MRSA Select, for detection of methicillin-resistant Staphylococcus aureus . J Clin Microbiol 2006;44:4561–4563.Google Scholar
32. Simor, AE, Ofher-Agostini, M, Bryce, E, et al. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001;165:21–26.Google Scholar
33. Afif, W, Huor, P, Brassard, P, Loo, VG. Compliance with methicillin-resistant Staphylococcus aureus precautions in a teaching hospital. Am J Infect Control 2002;30:430–433.Google Scholar