Rapid screening for carriage of Methicillin-resistant Staphylococcus aureus by polymerase chain reaction and associated costs

Department of Infectious Diseases, University Hospital Bern; Institute for Infectious Diseases, University of Bern; Bern, Switzerland

^* To whom correspondence should be addressed. Email: kathrin.muehlemann{at}ifik.unibe.ch.

	Abstract

PCR tests for rapid and valid detection of methicillin-resistant Staphylococcus aureus (MRSA) are now available. We evaluated the costs associated with contact screening for MRSA carriage in a tertiary care hospital with low MRSA endemicity. Between October 1, 2005 and February 28, 2006, 232 patients were screened during 258 screening episodes (644 samples) for MRSA carriage by GenoType® MRSA Direct (Hain Lifescience GmbH, Nehren, Germany). Conventional culture confirmed all PCR results. According to in-house algorithms 34 of 258 screening episodes (14.7%) would have qualified for preemptive contact isolation, but such isolation was not done upon negative PCR results. MRSA carriage was detected in four (1.5%) of 258 screening episodes (i.e. in four patients), whereof none qualified for preemptive contact isolation. The use of PCR for all 258 screening episodes added costs of CHF 104'328.- and saved CHF 38'528.- (for preemptive isolation). Restriction of PCR screening to the 34 episodes qualifying for preemptive contact isolation, and screening all others by culture only, would have lowered costs for PCR to CHF 11'988.-, but still saved CHF 38'528.-. Therefore, PCR tests are valuable for rapid detection of MRSA carriers, but high costs require careful evaluation of their use. In patient populations with low MRSA endemicity, broad use of PCR is probably not cost-efficient.