MRSA screening proves cost-effective in ICU study

Infection rate reduced by 14%

Carine C, Durand-Zaleski I, Alberti C, et al. Control of endemic methicillin-resistant Staphylococcus aureus: A cost benefit analysis in an intensive care unit. JAMA 1999; 282:1,745-1,751.

To compare the costs and benefits of an MRSA control program in an endemic setting, the authors conducted a case-control study conducted at a medical ICU in a French university hospital.

The total costs of acquiring methicillin-resistant Staphylococcus aureus infection in an intensive care unit of the hospital was $9,275, making selective screening and isolation of carriers on ICU admission a cost-effective intervention, the authors noted.

Total costs of the control program ranged from $340 to $1,480 per patient, but a 14% reduction in MRSA infection rate resulted in the control program being cost-beneficial, they reported.

"Targeted screening for MRSA carriage at admission to high-risk areas helps identify a substantial proportion of colonized patients and contributes to early implementation of contact isolation to reduce the risk of cross-transmission," the authors concluded. "Compared with no screening, this strategy appears to effectively reduce MRSA rates."

The hospital had a 4% prevalence of MRSA carriage at ICU admission. Researchers randomly selected 27 patients who had nosocomial MRSA infection and matched them with 27 controls hospitalized during the same period without MRSA infection. The excess length of stay attributable to MRSA infection was four days overall. The authors reported a total excess cost of or $9,275 for nosocomial MRSA infection, with the mean excess cost running about $3,500.

"Our study suggest that identification of MRSA carriers via selective screening and subsequent isolation is a beneficial strategy when compared with no screening and standard precautions," they found.