Universal screening for MRSA? not primetime Yet

Recently, there has been a lot of coverage in press about the “recent” epidemic of methicillin-resistant Staph Aureus (MRSA) infections. In reality, we know that the MRSA epidemic really isn’t new, but it is a huge problem that isn’t improving on its own. So what is the most effective way to reduce MRSA infections?

A study from Northwestern published in the Annals of Internal Medicine examined the outcomes of instituting a comprehensive MRSA screening in a large academic medical system. Starting in Arpil 2004, all patients admitted to an ICU had nasal swabs to test for MRSA colonization (74% adherence). Patients that were positive based on PCR testing were placed on contact isolation. After 12 months of this protocol, the surveillance program was expanded to the entire hospital system. During this phase of the study, patients that tested positive underwent decolonization with muciporin and a chlorhexidine wash/shower (how clean!). The study found a decrease in the incidence of MRSA disease by 70%. Most notably, while there was decreased MRSA surgical site and UTI, there was no statistically significant decrease in MRSA bacteremia with universal surveillance. Also since MRSA is associated with higher mortality, it’s odd that this study did not try to observe for decreased mortality. These results contradict the findings of a recent study published in JAMA  that did not find any significant reduction in surgical site infections with universal screening. While this study does not absolutely prove universal MRSA surveillance is ready for primetime, it is a significant step in creating a robust and sensible system to improve our detection and containment of MRSA transmission.