title: [Choice of a strategy for screening for methicillin-resistant Staphylococcus aureus on admission to rehabilitation units].
abstract: OBJECTIVE
  To identify a strategy of MRSA screening (methicillin-resistant Staphylococcus aureus) on admission to geriatric rehabilitation units, which would lead to acceptable efficacy and cost compared with a reference maximaliste strategy combining all six sampling sites. Method MRSA screening was conducted prospectively for 3 months in all the patients admitted to a geriatric follow-up and rehabilitation unit, using samples from the nostrils, armpits, urine scars cutaneous ulcers and sores. Six strategies were defined combing different sampling sites. Their efficacy and cost were compared with those of a maximaliste strategy combining the 6 sampling sites.
  
  
  RESULTS
  Combined screening of all six sites was the most effective but also the most expensive strategy. The least expensive strategy used only samples from ulcers and sores, but its efficacy was of only 45%. The strategy with the lowest loss of efficacy compared to the reference strategy combined the sampling of ulcers and sores and sampling from the nostrils: it was efficient in 91% and its cost was 2.5 fold lower than the cost of the reference strategy.
  
  
  CONCLUSIONS
  A preliminary, short term study established an MRSA screening strategy adapted to the specificities of a geriatric rehabilitation unit and its recruitment. The ability to define the optimal strategy for MRSA screening in a geriatric rehabilitation and follow-up unit may be an important factor in controlling the diffusion of MRSA.
authors.affiliation: Unité de prévention des infections nosocomiales, Département d'épidémiologie et de santé publique, CHU-Hôpitaux de Rouen. Marie-Pierre.Tavolacci@chu-rouen.fr
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Tavolacci
authors.forename: Véronique
authors.initials: V
authors.lastname: Merle
authors.forename: Michel
authors.initials: M
authors.lastname: Dupuis
authors.forename: Caroline
authors.initials: C
authors.lastname: Van Doren
authors.forename: Valérie
authors.initials: V
authors.lastname: Josset
authors.forename: Gérard
authors.initials: G
authors.lastname: Houdent
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Lemeland
authors.forename: Pierre
authors.initials: P
authors.lastname: Czernichow
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005853:Geriatrics; D006801:Humans; D008403:Mass Screening; D016106:Methicillin Resistance; D010343:Patient Admission; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012883:Skin Ulcer / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity*