Research
Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study
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* Corresponding author: Marjan Wassenberg M.W.M.Wassenberg@umcutrecht.nl
1 Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
2 Department of Internal Medicine and Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
3 Laboratory for Microbiology and Infection Control, Amphia Hospital, Molengracht 21, Breda, 4818 CK, The Netherlands
4 Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
5 Department of Medical Microbiology, Hygiene and Infection Prevention, Slingeland Hospital, Kruisbergseweg 25, Doetinchem, 7000 AD, The Netherlands
6 Public Health Laboratory Tilburg, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, 5022 GC, The Netherlands
7 Department of Medical Microbiology and Infection Prevention, Haga Hospital, Leyweg 275, The Hague, 2545 CH, The Netherlands
8 Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Geert Grooteplein-Zuid 10, Nijmegen, 6525 GA, The Netherlands
9 Laboratory of Medical Microbiology and Immunology, Diakonessenhuis, Bosboomstraat 1, Utrecht, 3582 KE, The Netherlands
10 Department of Medical Microbiology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
11 Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, Nijmegen, 6532 SZ, The Netherlands
12 Department of Medical Microbiology, CAPHRI, Maastricht University, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
13 Laboratory for Pathology and Medical Microbiology, PAMM Institute, De Run 6250, Veldhoven, 5504 DL, The Netherlands
14 Laboratory for Medical Microbiology and Immunology, Alysis Zorggroep, Wagnerlaan 55, Arnhem, 6815 AD, The Netherlands
15 National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands
16 Julius Center for Health Sciences and Primary Care, University Medical Center,Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
Critical Care 2012, 16:R22 doi:10.1186/cc11184
See related commentary by Lucet, http://ccforum.com/content/16/2/120
Published: 7 February 2012Abstract
Introduction
Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs).
Methods
Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT.
Results
A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert).
Conclusions
In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided.