Rapid screening for carriage of methicillin-resistant Staphylococcus aureus by PCR and associated costs

Abstract

PCR tests for the rapid and valid detection of methicillin-resistant Staphylococcus aureus (MRSA) are now available. We evaluated the costs associated with contact screening for MRSA carriage in a tertiary-care hospital with low MRSA endemicity. Between 1 October 2005 and 28 February 2006, 232 patients were screened during 258 screening episodes (644 samples) for MRSA carriage by GenoType MRSA Direct (Hain Lifescience GmbH, Nehren, Germany). Conventional culture confirmed all PCR results. According to in-house algorithms, 34 of 258 screening episodes (14.7%) would have qualified for preemptive contact isolation, but such isolation was not done upon negative PCR results. MRSA carriage was detected in 4 (1.5%) of 258 screening episodes (i.e., in four patients), of which none qualified for preemptive contact isolation. The use of PCR for all 258 screening episodes added costs (in Swiss francs [CHF]) of CHF 104,328.00 and saved CHF 38,528.00 (for preemptive isolation). The restriction of PCR screening to the 34 episodes that qualified for preemptive contact isolation and screening all others by culture would have lowered costs for PCR to only CHF 11,988.00, a savings of CHF 38,528.00. Therefore, PCR tests are valuable for the rapid detection of MRSA carriers, but high costs require the careful evaluation of their use. In patient populations with low MRSA endemicity, the broad use of PCR probably is not cost-effective.

FIG. 1.

Screening for MRSA carriage by PCR and manual culture was done in 258 screening episodes (involving 232 patients). The 34 screening episodes that qualified for preemptive contact isolation were screened by PCR on the same day (Fast PCR). The criteria for preemptive contact isolation were (i) sharing a room with a newly detected MRSA carrier or (ii) being transferred from another geographical region with high MRSA prevalence and the presence of any risk factor for MRSA colonization, including skin lesions, intratracheal tube, tracheostoma, urinary catheter, or wound drainage.