Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
Am J Infect Control. 2012 Jun;40(5):411-5. doi: 10.1016/j.ajic.2011.07.008. Epub 2011 Oct 2.
Screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective.
Our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects.
A prospective, nonrandomized observational study of screening nonrisk patients ≤72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups.
A total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ≤ .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001).
Screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients.
筛选耐甲氧西林金黄色葡萄球菌（MRSA）被提倡作为控制措施的一部分，但对所有入院患者进行筛查可能并不具有成本效益。
我们的目的是评估与仅对有危险因素的患者进行筛查相比，对所有入院患者进行筛查的额外收益，并评估成本方面。
在一家三级转诊医院进行了一项为期 3 年的前瞻性、非随机观察性研究，对≤72 小时入院的非风险患者进行了非风险患者筛查，并与仅对有危险因素的患者进行了筛查。我们还评估了筛查这两组患者的成本。
共 892 例患者中 48 例（5%）为 MRSA 阳性；第 1 年 314 例中有 28 例（9%），第 2 年 257 例中有 12 例（5%），第 3 年 321 例中有 8 例（2%）。非风险患者中的 MRSA 阳性患者明显少于 MRSA 风险患者：340 例中有 4 例（1%）与 552 例中有 44 例（8%），P≤0.0001。然而，对非风险患者进行筛查使筛查样本数量增加了 62%，同时筛查成本也相应增加。向后逐步逻辑回归模型确定年龄>70 岁、慢性肺部疾病诊断、既往 MRSA 感染和入院前 18 个月是区分入院时 MRSA 阳性和 MRSA 阴性患者的最重要独立预测因素（94.3%的准确性，P<0.001）。
对无危险因素的患者进行筛查增加了筛查数量和成本，但仅发现少数额外的病例。在 MRSA 流行的医院中，对入院时有危险因素的患者进行针对性筛查仍然是早期识别 MRSA 阳性患者的最有效策略。
