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Abstract

Aim: To establish the cost-effectiveness of screen-A ing and treating meticillin-sensitive Staphylococcus aureus (MSSA) carriers, potentially reducing both financial and clinical burdens of managing healthcare-acquired infections.

Methods: A decision health economic model analysed the impact of a ‘screen and treat’ strategy for Hospital inpatients from the perspective of the UK National Health Service.

Results: Cost savings in excess of £600k and around 840 potential infections could be avoided in a 70,000 patient cohort, at a nasal carriage prevalence of 30%. For 2000 high infection risk cardiothoracic surgery patients, cost savings could reach £8,636 per annum. The dominance of the ‘screen and treat’ strategy holds for plausible variations in the model parameter values and simple modelling of secondary transmission.

Conclusion: Adopting rapid screening and treating MSSA nasal carriers should be clinically and financially advantageous, compared to current strategies of not screening, even under conservative assumptions for costs and probabilities of managing infections.

Keywords

Staphylococcus aureus infection prevention and control MRSA

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References

BD Diagnostics (2009) BD GeneOhmTMStaphSR Assay. BD Diagnostics, European prospective clinical data.

Bode LG , Kluytmans JA , Wertheim HF , Bogaers D. , Vandenbroucke-Grauls CM , Roosendaal R. , Troelstra A. , Box AT , Voss A. , van der Tweel I. , van Belkum A. , Verbrugh HA , Vos MC ( 2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. New England Journal of Medicine 362(1): 9-17.

Coates T. , Bax R. , Coates A. (2009) Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects. Journal of Antimicrobial Chemotherapy 64(1): 9-15.

Chaix C. , Durand-Zaleski I. , Alberti C. , Brun-Buisson C. ( 1999) Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 282(18): 1745-51.

Cunningham R. , Jenks P. , Northwood J. , Wallis M. , Ferguson S. , Hunt S. ( 2007) Effect on MRSA transmission of rapid PCR testing of patients admitted to critical care. Journal of Hospital Infection 65: 24-8.

Curtis L. (2009) Unit costs of health and social care 2009. Personal Social Services Research Unit, University of Kent, Canterbury, UK.

Deshpande LM , Fix AM , Pfaller MA , Jones RN , SENTRY Antimicrobial Surveillance Program Participants Group (2002) Emerging elevated mupirocin resistance rates among staphylococcal isolates in the SENTRY Antimicrobial Surveillance Program (2000): correlations of results from disk diffusion, Etest and reference dilution methods. Diagnostic Microbiology and Infectious Diseas e 42(4): 283-90.

Drummond MF , Sculpher MJ , Torrance GW , O’Brien B. , Stoddart GL ( 2005)Methods for the economic evaluation of health care programmes , 3rd. edn. Oxford University Press: Oxford.

Edgeworth JD ( 2010) Has decolonization played a central role in the decline in UK methicillin-resistant Staphylococcus aureus transmission? A focus on evidence from intensive care? Journal of Antimicrobial Chemotherapy Advanced publication September 18, 2010.

10.

Jernigan JA , Clemence MA , Stott GA , Titus MG , Alexander CH , Palumbo CM , Farr BM ( 1995) Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infection Control and Hospital Epidemiology 16: 686-96.

11.

Keshtgar MR , Khalili A. , Coen PG , Carder C. , Macrae B. , Jeanes A. , Folan P. , Baker D. , Wren M. , Wilson AP ( 2008) Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards. British Journal of Surgery 95(3): 381-6.

12.

Kunori, T. , Cookson B. , Roberts JA , Stone S. , Kibler C. ( 2002) Cost-effectiveness of different MRSA screening methods . Journal of Hospital Infection 51: 189-200.

13.

Murthy A. , De Angelis G. , Pittet D. , Schrenzel J. , Uckay I. , Harbarth S. (2010) Cost-effectiveness of universal MRSA screening on admission to surgery . Clinical Microbiology and Infection 16(12): 1747-53.

14.

Patel JB , Gorwitz RJ , Jernigan JA ( 2009) Mupirocin resistance. Clinical Infectious Diseases 49(6): 935-41.

15.

Scott MA , Price CP , Cowie MR , Buxton MJ ( 2008) Consequences analysis of natriuretic peptide assays to refute symptomatic heart failure in primary care. British Journal of Cardiology 15(4): 199-204.

16.

van Rijen M. , Bonten M. , Wenzel R. , Kluytmans J. ( 2008) Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database of Systematic Eeviews (Online) 4(4): CD006216.

17.

Voss A. ( 2009) Healthcare associated infections. BMJ (Clinical research ed.) 339: b3721.

18.

Wenzel RP ( 2010) Minimizing surgical-site infections. New England Journal of Medicine 36 2(1): 75-7.

19.

Wilson AP , Hodgson B. , Liu M. , Plummer D. , Taylor I. , Roberts J. , Jit M. , Sherlaw-Johnson C. ( 2006) Reduction in wound infection rates by wound surveillance with postdischarge follow-up and feedback. British Journal of Surgery 93(5): 630-8.

20.

Wilson AP , Weavill C. , Burridge J. , Kelsey MC ( 1990) The use of the wound scoring method ‘ASEPSIS’ in postoperative wound surveillance. Journal of Hospital Infection 16(4): 297-309.

21.

Young LS , Winston LG ( 2006) Preoperative use of mupirocin for the prevention of healthcare-associated Staphylococcus aureus infections: a cost-effectiveness analysis. Infection Control and Hospital Epidemiology 27(12): 1304-31.

Rapid molecular screening for meticillin-sensitive Staphylococcus aureus (MSSA) carriage: an economic evaluation

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