A blinded comparison of three laboratory protocols for the identification of patients colonized with methicillin-resistant Staphylococcus aureus.
OBJECTIVE
To compare three laboratory screening protocols for the detection of methicillin-resistant Staphylococcus aureus (MRSA) from surveillance specimens (mannitol-salt agar containing 2 microg/mL of oxacillin [MSA-2], mannitol-salt agar containing 4 microg/mL of oxacillin [MSA-4], and a broth-containing protocol as recommended by the American Society for Microbiology [M-ASM]).


METHODS
Blinded comparative laboratory study and cost analysis.


METHODS
University-affiliated microbiology laboratory.


METHODS
Outcome measurements included rate of detection of MRSA-positive specimens and patients, turnaround time, and media and technologist costs. All MRSA culture swabs obtained from any patient site from November 1998 to April 1999 were included.


RESULTS
The M-ASM protocol detected between 19.1% and 32.0% more MRSA-positive specimens and between 13.3% and 23.3% more MRSA-positive patients per surveillance event than the MSA-4 and MSA-2 protocols, respectively. There was no difference in positive-culture reporting time between the M-ASM and MSA4 protocols. The broth-containing protocol was 2- to 2.5-fold more expensive than the simpler protocols, taking into account media and laboratory personnel costs.


CONCLUSIONS
It remains to be determined whether it is cost beneficial for a hospital to adopt the M-ASM, as the potential cost of MRSA transmission from unidentified MRSA-colonized patients is unknown. A broth-containing protocol should be considered the gold standard in future studies examining newer MRSA screening protocols
Gardam
M
M
Department of Microbiology, University Health Network, University of Toronto, Ontario, Canada.
Brunton
J
J
Willey
B
B
McGeer
A
A
Low
D
D
Conly
J
J
D019411:Clinical Laboratory Techniques / Q000592:standards*; D003365:Costs and Cost Analysis; D006801:Humans; D007753:Laboratories / Q000191:economics*; D016106:Methicillin Resistance; D008829:Microbiology; D009864:Ontario; D015203:Reproducibility of Results; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification