Screening for MRSA

We note with interest the comments of Wilcox(1) regarding the scarcity of robust data to inform MRSA management strategies and the need for further large studies to determine which patient groups would benefit most from screening at admission.

In our health technology assessment (HTA) of screening for MRSA on admission to hospital published in September 2007(2) we concluded that “the economic modelling indicated that systematic screening for MRSA of patients admitted to hospital would reduce prevalence of MRSA; this should be tested by conducting a primary study within Scottish hospitals”

Since publication of our report a number of studies of screening for MRSA on hospital admission have been published. Jeyaratnum et al.(3) and Harbarth et al.(4) both reported that screening did not reduce nosocomial MRSA infections, however, Robicsek et al.(5) reported a large reduction in the incidence of MRSA during hospital admission and beyond. One of the notable differences between the study showing a reduction and those not showing a reduction in MRSA infections was that the Robicsek study was of universal screening, rather than screening of particular patient groups or wards. There were of course a number of other differences, but it has been previously suggested that a regional approach is required to realise the full benefits of screening (Smith et al.(6))

Following publication of the NHS QIS HTA, the Scottish Government decided to fund a primary study. Under the management of Health Protection Scotland (HPS), three NHS Boards in Scotland will pilot the HTA recommendations. The Boards will be expected to commence data collection by summer 2008 and a report on the feasibility of implementing screening will be submitted to the Scottish Government in April 2009. Data collection within Boards will continue until a complete year of data is available and a further report on the outcomes of the pilot is to be submitted by HPS by the end of 2009.

It is anticipated that this study will provide evidence to inform the debate on the effectiveness of a universal screening programme where MRSA is endemic. It will also provide key data, currently unavailable, such as the prevalence of MRSA colonisation in the Scottish patient population.

(1) Wilcox MH. Screening for MRSA. BMJ 2008;336:899-900.

(2) Ritchie, K, Bradbury, I, Craig, J, Eastgate, J, Foster, L, Kohli, H, Iqbal, K, Macpherson, K, McCarthy, T, McIntosh, H, Nic Lochalainn, E, Reid, M, and Taylor, J. The clinical and cost effectiveness of screening for methicillin-resistant Staphylococcus aureus (MRSA). 2007. Glasgow, NHS QIS. Ref Type: Report

(3) Jeyaratnam D, Whitty CJ, Phillips K, Liu D, Orezzi C, Ajoku U et al. Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ 2008;336:927-30.

(4) Harbarth S, Fankhauser C, Schrenzel J, Christenson J, Gervaz P, Bandiera-Clerc C et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149-57.

(5) Robicsek A, Beaumont JL, Paule SM, Hacek DM, Thomson RB, Jr., Kaul KL et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409-18.

(6) Smith D, Dushoff J, Perencevich E, Harris A, Levin S. Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: resistance is a regional problem. PNAS 2004;101:3709-14.

karenritchie@nhs.net

Competing interests: None declared