title: Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years' Experience.
abstract: OBJECTIVE
  To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy. DESIGN Screening study and cost-effectiveness analysis.
  
  
  METHODS
  Analysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate).
  
  
  RESULTS
  There were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548).
  
  
  CONCLUSIONS
  In an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.
authors.affiliation: 1Department of Infectious Diseases,Bern University Hospital,Bern,Switzerland.
authors.forename: H M
authors.initials: HM
authors.lastname: Gebreselassie
authors.affiliation: 1Department of Infectious Diseases,Bern University Hospital,Bern,Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Kaspar
authors.affiliation: 2Institute for Infectious Diseases,University of Bern,Bern,Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Droz
authors.affiliation: 1Department of Infectious Diseases,Bern University Hospital,Bern,Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Marschall
mesh_terms: D000368:Aged; D002353:Carrier State / Q000175:diagnosis* / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology*