Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward.
OBJECTIVE
To compare two strategies for screening methicillin-resistant Staphylococcus aureus (MRSA) carriers in a high-risk dermatology ward: systematic screening of all admitted patients versus selective screening of patients at risk.


METHODS
The two strategies were applied prospectively during two consecutive periods. In period A (8.5 months), only patients transferred from other wards, or with a history of prior hospitalization, or presenting chronic wounds or disease with denuded skin were considered at high risk of MRSA carriage and sampled. In period B (7.5 months), all admitted patients were systematically screened. End-points were the number of patients having a MRSA-positive screening sample on admission during period B and having none of the risk factors used in period A, the rate of imported MRSA cases, and the rate of acquired cases.


METHODS
A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses.


METHODS
The study included 729 dermatology inpatients (370 in period A and 359 in period B).


RESULTS
During period A, screening samples were obtained on admission for 30% of patients (77% of the patients at risk) and identified 25 MRSA carriers. During period B, 90.5% of admitted patients were screened, and 26 MRSA carriers were detected on admission; all of these patients belonged to at least one predefined category at risk for carriage. Overall rates of imported and acquired cases were similar between the two periods (6.8% vs 7.5%, and 2.9% vs 2.4%, respectively).


CONCLUSIONS
A screening strategy targeted to patients at risk of harboring MRSA has similar sensitivity and is more cost-effective than a strategy of systematic screening to identify MRSA carriers on admission.
Girou
E
E
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France.
Azar
J
J
Wolkenstein
P
P
Cizeau
F
F
Brun-Buisson
C
C
Roujeau
J C
JC
D003428:Cross Infection / Q000175:diagnosis*; D003880:Dermatology; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D008403:Mass Screening; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D010343:Patient Admission; D012307:Risk Factors; D012871:Skin Diseases / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000472:pathogenicity; D014947:Wounds and Injuries / Q000382:microbiology