Abstract
BackgroundMethicillin resistant Staphylococcus aureus (MRSA) are often resistant to multiple classes of antibiotics. The research objectives of this systematic review were to evaluate the clinical effectiveness of polymerase chain reaction (PCR) versus chromogenic agar for MRSA screening, and PCR versus no screening for several clinical outcomes, including MRSA colonization and infection rates.MethodsAn electronic literature search was conducted on studies evaluating polymerase chain reaction techniques and methicillin (also spelled meticillin) resistant Staphylococcus aureus that were published from 1993 onwards using Medline, Medline In-Process & Other Non-Indexed Citations, BIOSIS Previews, and EMBASE. Due to the presence of heterogeneity in the selected studies, the clinical findings of individual studies were described.ResultsNine studies that compared screening for MRSA using PCR versus screening using chromogenic agar in a hospital setting, and two studies that compared screening using PCR with no or targeted screening were identified. Some studies found lower MRSA colonization and acquisition, infection, and transmission rates in screening with PCR versus screening with chromogenic agar, and the turnaround time for screening test results was lower for PCR. One study reported a lower number of unnecessary isolation days with screening using PCR versus screening with chromogenic agar, but the proportion of patients isolated was similar between both groups. The turnaround time for test results and number of isolation days were lower for PCR versus chromogenic agar for MRSA screening.ConclusionsThe use of PCR for MRSA screening demonstrated a lower turnaround time and number of isolation days compared with chromogenic agar. Given the mixed quality and number of studies (11 studies), gaps remain in the published literature and the evidence remains insufficient. In addition to screening, factors such as the number of contacts between healthcare workers and patients, number of patients attended by one healthcare worker per day, probability of colonization among healthcare workers, and MRSA status of hospital shared equipment and hospital environment must be considered to control the transmission of MRSA in a hospital setting.
Highlights
Methicillin resistant Staphylococcus aureus (MRSA) are often resistant to multiple classes of antibiotics
Studies were excluded if the study participants were not limited to hospitalized patients, used an inappropriate intervention or comparators, or no comparators, were not performed in a hospital setting, did not examine hospital-acquired MRSA or measured the wrong outcomes
MRSA colonization, infection, and transmission rates were lower using polymerase chain reaction (PCR) for screening versus chromogenic agar, but the possibility of a null difference could not be excluded based on the 95% confidence intervals (CIs) in most cases
Summary
Methicillin resistant Staphylococcus aureus (MRSA) are often resistant to multiple classes of antibiotics. MRSA has been associated with many infection sites including bones and joints, lungs, and the urinary tract [2]. A national MRSA prevalence study by the Association for Professionals in Infection Control and Epidemiology, Inc., conducted in 2006, determined that 46 out of every 1,000 patients in the United States were either MRSA colonized or infected [4]. The incidence of MRSA in 47 sentinel, geographically-dispersed Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program in 2007 was 8.62 cases (2.57 infection and 5.87 colonization) per 1,000 patient admissions and 11.63 cases (3.47 infection and 7.92 colonization) per 10,000. In Europe, the 2007 incidence of MRSA bloodstream infection per 100,000 patient days ranged from 0.2 in Sweden to 2.4 in Portugal [6]
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