title: [Generalized or targeted screening for carriage of MRSA on admission to a geriatric hospital].
abstract: OBJECTIVE
  To confirm previously risk factors for MRSA carriage in our geriatric patient population and to suggest a simplified risk score with a combination of these risk factors, to test the Novel Score and to check if a targeted MRSA screening on admission is possible to reduce the screening workload and cost.
  
  
  METHODS
  a prospective in-hospital cohort study.
  
  
  METHODS
  1125 geriatric patients were screened for MRSA carriage within 24 hours after admission to a geriatric hospital.
  
  
  METHODS
  Risk factors, based on recently published risk scores (Preop Score and Ger Score) were determined.
  
  
  RESULTS
  Prevalence of MRSA carriage was 8.44%. In a multivariate analysis age > or = 87 year (OR 1,864; 95% CI 1,145-3,035), presence of a long-term catheter (OR 2,813; 95% CI 1,562-5,065) and prior carriage of MRSA (OR 13,25; 95% CI 8,007-21,926) remained predictors of MRSA carriage. The Novel Score (cut-off > or = 1) had a sensitivity of 73.7%, a specificity of 64%, PPV 15.9%, NPV 96.3% and AUC of 0.688. The Novel Score allows reduction of the screening load by 57.2%, but misses 26% of positive cases. 16% of MRSA carriers develop an infection that needs to be treated with vancomycin.
  
  
  CONCLUSIONS
  With targeted MRSA screening on admission based on a risk score a substantial reduction of workload and costs is possible compared to generalized screening for MRSA. Because MRSA carriers can be missed with a risk score, the epidemiological context and the risk of transmission and infection with MRSA must be taken in to account when introducing a targeted screening.
authors: Dienst Geriatrie, Universitaire Ziekenhuizen Leuven, België. nele_myngheer@hotmail.com
authors: N
authors: N
authors: Myngheer
authors: A
authors: A
authors: Schuermans
authors: J
authors: J
authors: Flamaing
mesh_terms: D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis / Q000382:microbiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission