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The debate over how to control the drug-resistant bacteria, Staphylococcus Aureus, or MRSA, rages on. According to the latest U.S. study released March 17, universal testing of hospital patients to find and treat carriers of MRSA can curtail outbreaks. However, these findings contradict the results of a Geneva, Switzerland hospital study published just a week ago which concluded that the cost of universal MRSA testing outweighs the benefits.
Adding to the controversy is the fact that several researchers with financial ties to a manufacturer of a test for MRSA, Becton Dickinson and Company, are among the authors of the new study.
The four-year study, published in "Annals of Internal Medicine," focused on three suburban Chicago hospitals. Researchers compared MRSA infection rates when there was no screening protocol, to when only intensive care patients were screened, and to when, over a 21-month period, nearly all patients were tested. Without the screening there were nearly 9 new infections per 10,000 days of patient care. Infections declined to approximately 4 per 10,000 patient-days after universal testing was put into place.
In a statement, Dr. Lance Peterson of Evanston Northwestern Healthcare in Illinois, who worked on the study said, "The program we began in August of 2005 had a major impact for all our patients and demonstrated that a comprehensive effort to reduce MRSA infection can be accomplished."
Even though the new study reflected reduced infection rates of 70 percent, some researchers still question whether universal screening is the solution to the problem.
Dr. Ebbing Lautenbach of the University Of Pennsylvania School of Medicine, whose commentary accompanied the study, admitted that the test results were impressive but suggested that the decrease in illness could have been due to better hand-washing practices and cleaning practices by hospital staff. He also said it is unclear which part of the Evanston Northwestern universal screening intervention worked. "How MRSA behaves in one hospital can be very different from how it behaves in another hospital. You really need more information at the hospital level to figure out what makes sense for that given hospital." Dr. Lautenbach concluded that until further evidence comes in, "each institution may need to tailor its intervention to its unique needs and resources."
Dr. Lautenbach noted that targeting high-risk populations for screening, such as nursing home residents, may be a more cost-effective way to confront MRSA infection. Furthermore, with the PCR-based test costing $25 to $30, compared to the $5 standard culture lab test, screening all patients with the fast test used in the Chicago hospitals could have an economic impact on the hospitals.
It is estimated that as many as 1.5 percent of Americans carry MRSA. While not developing an infection themselves, they may spread it to others, especially in a hospital setting where weakened patients are susceptible. In 2005, MRSA was blamed for 19,000 deaths in the U.S.
Several states, including Illinois, have legislated uniform surveillance for MRSA in healthcare settings, and Congress recently began deliberations on the Strategies to Address Antimicrobial Resistance Act (STAAR) to boost federal efforts at surveillance, prevention and control.
However, the Center for Disease Control (CDC), as well as other organizations have recommended against routine or mandated surveillance. According to a statement from the Association for Professionals in Infection Control and Epidemiology, while surveillance can be an important tool against MRSA, "mandated screening limits a hospital's flexibility to design infection prevention programs that will best protect their patient population."
Hospitals are also likely to face an added financial risk in October when the Medicare and Medicaid health insurance programs plan to halt the reimbursements for treatment of hospital-acquired infections and other "preventable" conditions.
