Center for Orthopaedic Excellence at Syosset Hospital, Syosset, NY, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
J Hosp Infect. 2023 Aug;138:27-33. doi: 10.1016/j.jhin.2023.05.012. Epub 2023 Jun 3.
For patients undergoing total joint arthroplasty (TJA), pre-admission meticillin-resistant Staphylococcus aureus (MRSA) nasal screening has been widely adopted to prevent postoperative joint infection. However, screening cost-effectiveness and clinical utility have not been adequately evaluated.
To assess the MRSA infection rate, associated costs, and costs of screening at our institution, before and after screening implementation.
This was a retrospective cohort study examining patients who underwent TJA at a health system in New York State, between 2005 and 2016. Patients were divided into the 'no-screening' group if the operation occurred prior to adoption of the MRSA screening protocol in 2011 and the 'screening' group if afterwards. The number of MRSA joint infections, cost of each infection, and costs associated with preoperative screening were recorded. Fisher's exact test and cost comparison analysis were performed.
The no-screening group had four MRSA infections in 6088 patients over a seven-year period, whereas the screening group had two in 5177 patients over five years. Fisher's exact test showed no significant association between screening and MRSA infection rate (P = 0.694). The cost of postoperative MRSA joint infection treatment was US$40,919.13 per patient, whereas annual nasal screening was US$103,999.97.
At our institution, MRSA screening had little impact on infection rates and led to increased costs, with 2.5 MRSA infections required annually to meet the costs of screening. Therefore, the screening protocol may be best suited for high-risk populations, rather than the average TJA patient. The authors recommend a similar clinical utility and cost-effectiveness analysis at other institutions implementing MRSA screening programmes.
对于接受全关节置换术（TJA）的患者，术前耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔筛查已广泛用于预防术后关节感染。然而，筛查的成本效益和临床实用性尚未得到充分评估。
在我们机构评估 MRSA 感染率、相关成本以及筛查前后的筛查成本。
这是一项回顾性队列研究，研究对象为 2005 年至 2016 年期间在纽约州一家医疗系统接受 TJA 的患者。如果手术发生在 2011 年采用 MRSA 筛查方案之前，则将患者分为“无筛查”组，如果在之后则为“筛查”组。记录了 MRSA 关节感染的数量、每个感染的成本以及与术前筛查相关的成本。进行了 Fisher 确切检验和成本比较分析。
在七年期间，无筛查组的 6088 例患者中有 4 例发生 MRSA 感染，而筛查组的 5177 例患者中有 2 例发生感染。Fisher 确切检验显示筛查与 MRSA 感染率之间无显著关联（P=0.694）。术后 MRSA 关节感染治疗的成本为每位患者 40919.13 美元，而每年鼻腔筛查的成本为 103999.97 美元。
在我们机构，MRSA 筛查对感染率影响不大，导致成本增加，每年需要 2.5 例 MRSA 感染才能达到筛查成本。因此，该筛查方案可能更适合高危人群，而不是普通 TJA 患者。作者建议在其他实施 MRSA 筛查计划的机构进行类似的临床实用性和成本效益分析。
