[BMJ]Impact of rapid screening tests on acquisition of MRSA

蓝鱼o_0

Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial

BMJ 2008;336;927-930; originally published online 16 Apr 2008;

ABSTRACT
Objective To determine whether introducing a rapid test for meticillin resistant Staphylococcus aureus (MRSA)
screening leads to a reduction in MRSA acquisition on hospital general wards.
Design Cluster randomised crossover trial. Setting Medical, surgical, elderly care, and oncology
wards of a London teaching hospital on two sites.
Main outcome measureMRSAacquisition rate (proportion of patients negative for MRSA who became MRSA
positive). Participants All patients admitted to the study wards who were MRSA negative on admission and screened for MRSA
on discharge. Intervention Rapid polymerase chain reaction based screening test for MRSA compared with conventional
culture. Results Of 9608 patients admitted to study wards, 8374 met entry criteria and 6888 had full data (82.3%); 3335 in
the control arm and 3553 in the rapid test arm. The overall MRSA carriage rate on admission was 6.7%. Rapid tests
led to a reduction in median reporting time from admission, from 46 to 22 hours (P<0.001). Rapid testing also reduced the number of inappropriate pre-emptive isolation days between the control and intervention arms (399 v 277, P<0.001). This was not seen in other measurements of resource use. MRSA was acquired by 108 (3.2%) patients in the control arm and 99 (2.8%) in
the intervention arm. When predefined confounding factors were taken into account the adjusted odds ratio
was 0.91 (95% confidence interval 0.61 to 1.234). Rates of MRSA transmission, wound infection, and bacteraemia
were not statistically different between the two arms.
Conclusion A rapid test forMRSAled to the quick receipt of results and had an impact on bed usage. No evidence was
found of a significant reduction in MRSA acquisition and on these data it is unlikely that the increased costs of rapid
tests can be justified compared with alternative control measures against MRSA.