Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study.
BACKGROUND
Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs).


METHODS
Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT.


RESULTS
A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n=5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert).


CONCLUSIONS
In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided.
Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands. M.W.M.Wassenberg@umcutrecht.nl
Marjan
M
Wassenberg
Jan
J
Kluytmans
Stephanie
S
Erdkamp
Ron
R
Bosboom
Anton
A
Buiting
Erika
E
van Elzakker
Willem
W
Melchers
Steven
S
Thijsen
Annet
A
Troelstra
Christina
C
Vandenbroucke-Grauls
Caroline
C
Visser
Andreas
A
Voss
Petra
P
Wolffs
Mireille
M
Wulf
Ton
T
van Zwet
Ardine
A
de Wit
Marc
M
Bonten
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000191:economics* / Q000517:prevention & control; D013997:Time Factors; D055815:Young Adult