Abstract
BackgroundThe screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA) is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed.Methodology/Principal FindingsDuring a four-week period, all 24 acute care hospitals of the State of Saarland participated in admission prevalence screening. Overall, 436/20,027 screened patients revealed MRSA carrier status (prevalence, 2.2/100 patients) with geriatrics and intensive care departments associated with highest prevalence (7.6/100 and 6.3/100, respectively). Risk factor analysis among 17,975 admission patients yielded MRSA history (OR, 4.3; CI95 2.7–6.8), a skin condition (OR, 3.2; CI95 2.1–5.0), and/or an indwelling catheter (OR, 2.2; CI95 1.4–3.5) among the leading risks. Hierarchical risk factor ascertainment of the six risk factors associated with highest odd’s ratios would require 31% of patients to be laboratory screened to allow for detection of 67% of all MRSA positive admission patients in the State.Conclusions/SignificanceState-wide admission prevalence screening in conjunction with risk factor ascertainment yields important information on the distribution of the MRSA burden for hospitals, and allows for data-based decisions on local or institutional MRSA screening policies considering risk factor prevalence and expected MRSA identification rates.
Highlights
Methicillin resistant Staphylococcus aureus (MRSA) is a major cause for healthcare associated infections (HAI), and considered a relevant patient safety issue
Risk factors have been associated with methicillin resistant Staphylococcus aureus (MRSA) carriage and invasive disease [1,2], yet, it has become clear that risk factors for MRSA acquisition in the hospital have to be separated from those associated with patients already MRSApositive upon hospital entry
In German hospitals, an MRSA point prevalence or on-admission prevalence between 0.7/100 and 5.3/100 [40,41] was reported
Summary
Methicillin resistant Staphylococcus aureus (MRSA) is a major cause for healthcare associated infections (HAI), and considered a relevant patient safety issue. In a consensus statement the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) concluded that policies should be guided by local MRSA infection and colonization rates [8]. This consensus statement has recently been updated [9]. Guideline implementation, and policy making, the issue of an optimal cost-effective and patients safety-focussed approach towards admission screening remains debated as carefully performed studies have come to contrasting results [10,11,12]). The screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA) is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed
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