title: Review of a major epidemic of methicillin-resistant Staphylococcus aureus: the costs of screening and consequences of outbreak management.
abstract: BACKGROUND
  A major outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in locations C and Z of our hospital and lasted for several years. It affected 1,230 patients and 153 personnel.
  
  
  METHODS
  Outbreak management was installed according to the Dutch "search and destroy" policy. A rapid, high-throughput method for molecular screening of potential MRSA carriers was implemented. Outbreak isolates were retrospectively genotyped by pulsed field gel electrophoresis. Costs of molecular screening were compared with screening by culture.
  
  
  RESULTS
  Genotyping results revealed 4 distinct epidemic MRSA clones. Three were present in hospital C. Because of a merger of hospitals, these clones spread to hospital Z. Another clone of MRSA affected other health care-related institutions in the region. Because of the implementation of strict containment measures of the "search and destroy" policy, the annual number of tests decreased from 100,000 to 18,000. The disposables and reagents used in polymerase chain reaction technology are more expensive than those of conventional methods. However, the clinical and economic benefits of fast results in regard to expenses of the hospital clearly outweigh the higher costs of screening.
  
  
  CONCLUSIONS
  The implementation of a rapid, high-throughput molecular screening system greatly contributed to the effectiveness of strict containment measures of the "search and destroy" policy. The major epidemic clones of MRSA in the outbreak were eradicated by this strategy.
authors.affiliation: Molecular Diagnostics Unit, Maasstad Hospital, Rotterdam, The Netherlands. zeea@maasstadziekenhuis.nl
authors.forename: Anneke
authors.initials: A
authors.lastname: van der Zee
authors.forename: Willem D H
authors.initials: WD
authors.lastname: Hendriks
authors.forename: Lieuwe
authors.initials: L
authors.lastname: Roorda
authors.forename: Jacobus M
authors.initials: JM
authors.lastname: Ossewaarde
authors.forename: Johannes
authors.initials: J
authors.lastname: Buitenwerf
mesh_terms: D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000191:economics* / Q000517:prevention & control*; D016521:Electrophoresis, Gel, Pulsed-Field; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000191:economics*; D008403:Mass Screening / Q000191:economics*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D009426:Netherlands / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control