Cost-effectiveness of rapid MRSA screening in surgical patients.
This study investigates the effectiveness of a same-day polymerase chain reaction (PCR) test for the rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) in a general screening of patients admitted to the trauma surgery and heart surgery department in a German university hospital. A total of 442 patients were screened over a 4-month period by using a PCR assay, compared to culture methods, for specimens from the nose and throat. The MRSA carriage rate on admission was 3.85% during the study period. The PCR results of 1,680 swabs showed a sensitivity of 85% and a specificity of 99.39% for swabs from the nares and for the throat 42.11% and 98.78%, respectively. A combination of specimens from the nose and throat from the same patient led to a sensitivity of 100% with a specificity of 98.29%. Cost calculation under the circumstances of a diagnosis-related groups (DRG) payment system found that the eight MRSA-positive patients created costs of 38,472 euros, i.e. 4,809 euros per patient, facing screening costs of 36.62 euros per sample. Screening patients by using the rapid PCR assay for a combination of specimens from the nose and throat would offer a safe and cost-effective way of MRSA screening on admission.
Schulz
Marten
M
Institute of Medical Microbiology and Hygiene, Philipps University Marburg, Hans-Meerwein-Strasse 2, 35043, Marburg, Germany.
Nonnenmacher
Claudia
C
Mutters
Reinier
R
D002353:Carrier State / Q000175:diagnosis* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D046508:Culture Techniques / Q000191:economics / Q000379:methods; D003953:Diagnosis-Related Groups / Q000191:economics; D005858:Germany; D006801:Humans; D007297:Inpatients; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D025202:Molecular Diagnostic Techniques / Q000191:economics / Q000379:methods; D009666:Nose / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000191:economics* / Q000379:methods; D015995:Prevalence; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D013503:Surgery Department, Hospital / Q000191:economics; D013997:Time Factors