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Real-Time Polymerase Chain Reaction Detection of Methicillin-Resistant Staphylococcus aureus: Impact on Nosocomial Transmission and Costs

Published online by Cambridge University Press:  02 January 2015

L. O. Conterno ,
J. Shymanski ,
K. Ramotar ,
B. Toye ,
C. van Walraven ,
D. Coyle  and
V. R. Roth
L. O. Conterno
Affiliation:
Division of Infectious Diseases, Marilia Medical School, Marilia, Sao Paulo, Brazil
J. Shymanski
Affiliation:
Ottawa Hospital, Ottawa, Ontario
K. Ramotar
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario
B. Toye
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario
C. van Walraven
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
D. Coyle
Affiliation:
University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario
V. R. Roth*
Affiliation:
Ottawa Hospital, Ottawa, Ontario University of Ottawa, Ottawa, Ontario Ottawa Health Research Institute, Ottawa, Ontario
*
Division of Infectious Diseases, Ottawa Hospital, 510 Smyth Rd., Room G12, Ottawa, Ontario, CanadaK1H 8L6 ([email protected])
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Abstract

Objectives.

To assess the impact of real-time polymerase chain reaction (PCR) detection of methicillin-resistant Staphylococcus aureus (MRSA) on nosocomial transmission and costs.

Design.

Monthly MRSA detection rates were measured from April 1, 2000, through December 31, 2005. Time series analysis was used to identify changes in MRSA detection rates, and decision analysis was used to compare the costs of detection by PCR and by culture.

Setting.

A 1,200-bed, tertiary care hospital in Canada.

Patients.

Admitted patients at high risk for MRSA colonization. MRSA detection using culture-based screening was compared with a commercial PCR assay.

Results.

The mean monthly incidence of nosocomial MRSA colonization or infection was 0.37 cases per 1,000 patient-days. The time-series model indicated an insignificant decrease of 0.14 cases per 1,000 patient-days per month (95% confidence interval, —0.18 to 0.46) after the introduction of PCR detection (P = .39). The mean interval from a reported positive result until contact precautions were initiated decreased from 3.8 to 1.6 days (P<.001). However, the cost of MRSA control increased from Can$605,034 to Can$771,609. Of 290 PCR-positive patients, 120 (41.4%) were placed under contact precautions unnecessarily because of low specificity of the PCR assay used in the study; these patients contributed 37% of the increased cost. The modeling study predicted that the cost per patient would be higher with detection by PCR (Can$96) than by culture (Can$67).

Conclusion.

Detection of MRSA by the PCR assay evaluated in this study was more costly than detection by culture for reducing MRSA transmission in our hospital. The cost benefit of screening by PCR varies according to incidences of MRSA colonization and infection, the predictive values of the assay used, and rates of compliance with infection control measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 10 , October 2007 , pp. 1134 - 1141
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

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