Update on screening and clinical diagnosis of meticillin-resistant Staphylococcus aureus (MRSA)

• Published in: International journal of antimicrobial agents Vol. 37; no. 2; pp. 110 - 117
• Main Authors: Harbarth, Stephan, Hawkey, Peter M, Tenover, Fred, Stefani, Stefania, Pantosti, Annalisa, Struelens, Marc J
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.02.2011; Elsevier
• Subjects: anti-infective agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial diseases; Bacteriological Techniques - methods; Biological and medical sciences; Carriage; Carrier State - diagnosis; Carrier State - drug therapy; Carrier State - microbiology; Clinical studies; clinical trials; control methods; cost effectiveness; Diagnostic Tests, Routine - methods; Diagnostics; disease control; disease transmission; Economics; hospitals; Human bacterial diseases; Humans; Infection; Infectious Disease; Infectious diseases; Mass Screening - methods; Medical sciences; Methicillin-Resistant Staphylococcus aureus - isolation & purification; MRSA; patients; Pharmacology. Drug treatments; Prevention; risk; screening; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Infection; Economics; Prevention; Diagnostics; MRSA; Clinical studies; Carriage; Updating; Medical screening; Screening; Symptomatology; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Economic aspect; Diagnosis; Staphylococcal infection; Colonization; Staphylococcus aureus
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2010.10.022

Based on the failure of conventional control strategies, some experts and public health officials have promoted active screening to detect asymptomatic carriers of meticillin-resistant Staphylococcus aureus (MRSA) as an effective prevention strategy. Data regarding the (cost-) effectiveness of MRSA screening have recently grown and have produced mixed results. Several clinical studies have not only provided conflicting findings but have also raised numerous issues about the appropriate populations for universal versus targeted screening, screening method(s) and intervention(s). It must also be emphasised that screening alone is not effective. Results should be followed by appropriate interventions to reduce the risk of MRSA transmission and infection. We believe a reasonable approach in most European hospitals with an MRSA on-admission prevalence of <5% is to use targeted rather than universal screening (predominantly with chromogenic media, except for high-risk units and critically ill patients for whom molecular tests could be cost effective), after carefully considering the local MRSA epidemiology, infection control practices and vulnerability of the patient population. This strategy is likely to be cost effective if linked to prompt institution of control measures.