Routine screening for methicillin-resistant Staphylococcus aureus.
BACKGROUND
The prevalence of asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) in the general population is increasing and now is estimated to be 5%-10%. Although the overall prevalence of MRSA infections in hospitals may be decreasing, it remains important, as asymptomatic carriers are at risk for infections of the skin and soft tissues, including surgical site infections (SSIs). Given the morbidity and cost of such infections, it has been hypothesized that identification of the carrier state, and subsequent eradication, will decrease the risk of MRSA infection.


METHODS
Review of pertinent English-language literature.


RESULTS
Asymptomatic MRSA carriers are at approximately 30-fold greater risk of SSI. However, the literature is conflicting as to whether identification of the MRSA carrier state, with targeted intervention thereafter, reduces the incidence of subsequent MRSA infection. Screening with polymerase chain reaction-based methodology is rapid and more accurate than conventional swab cultures (usually of the nares) but also more expensive.


CONCLUSIONS
Screening programs for MRSA colonization are expensive and of dubious utility. Universal screening of large populations is not cost-effective, whereas targeted screening of high-risk populations may deserve additional study. Standard infection control practices, diligent hand hygiene, and careful antimicrobial stewardship remain the tenets of prevention of MRSA infections.
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. nparks5@uthsc.edu
Nancy A
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Parks
Martin A
MA
Croce
D015373:Bacterial Typing Techniques / Q000379:methods; D002353:Carrier State / Q000382:microbiology*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D013203:Staphylococcal Infections / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000382:microbiology