Excerpt

Methicillin-resistant Staphylococcus aureus (MRSA) emerged as a clinically relevant human pathogen more than 5 decades ago. The virulent bacterium was first detected in hospitals and other health care facilities where vulnerable hosts, frequent exposure to the selective pressure of intensive antimicrobial therapy, and the necessity for invasive procedures created a favorable environment for dissemination. MRSA emerged as an important cause of health care-acquired infections, particularly central line-associated bloodstream infection, ventilator-associated pneumonia, and surgical site infection.

Despite the adoption of infection control measures, the incidence of MRSA infection at most hospitals in the United States (U.S.) steadily increased for many years, but is now decreasing. Routine clinical cultures may miss a large portion of patients who are silent carriers of these organisms and serve as reservoirs for further transmission. More aggressive measures have been sought to check the spread of this particularly virulent pathogen. Active surveillance screening for MRSA is receiving greater attention for its potential value in identifying carriers of MRSA to prevent further transmission.

To identify the population of colonized individuals, microbiological samples are obtained from at-risk patients even in the absence of signs or symptoms of infection. The screening strategy may use a testing modality with a rapid turnaround time (results available on the same day as the testing is performed, typically using polymerase chain reaction (PCR), intermediate turnaround time (results available next day to 2 days after testing performed) or longer turnaround time (results available greater than 2 days after testing performed, typically culture). Because screening alone is not expected to affect health outcomes, screening strategies may include screening with or without isolation and with or without attempted decolonization or eradication. By detecting the larger population of colonized individuals, at the very least conventional precautions (i.e., hand hygiene and contact isolation) can be implemented in a broader and timelier manner to interrupt horizontal transmission of MRSA. Detection of colonized patients also permits consideration of more aggressive interventions, including attempts at microbiological eradication or decolonization.

A Comparative Effectiveness Review (CER) was prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (BCBSA TEC EPC) on Screening for Methicillin-Resistant Staphylococcus aureus (MRSA). The objective of the CER was to synthesize comparative studies that examined the benefits or harms of screening for MRSA carriage in the inpatient or outpatient settings.¹ The review examined MRSA-screening strategies applied to all hospitalized or ambulatory patients (universal screening), as well as screening strategies applied to selected inpatient or outpatient populations (e.g., patients admitted to the intensive care unit (ICU), patients admitted for a surgical procedure, or patients at high-risk of MRSA colonization or infection such those on prolonged antibiotic therapy) and compared them to no screening or to screening of selected patient populations (targeted screening). The review evaluated MRSA-screening strategies with or without isolation and with or without attempted eradication/decolonization.

Contents

• Preface
• Acknowledgments
• Stakeholder Panel
• Executive Summary
• Introduction
  • Background
• Methods
  • Identification of Research Needs
  • Literature Search Update
  • Criteria for Prioritization
• Results
  • Research Needs
  • Research Questions
  • Study Design Considerations
• Discussion and Conclusions
• References
• Abbreviations
• Appendix A Summary of Evidence From Draft Comparative Effectiveness Review
• Appendix B Search Strategies for Updating of Evidence
• Appendix C Survey Tool Used To Rate Research Needs
• Appendix D Survey Tool Used To Rate Research Questions
• Appendix E List of Research Needs
• Appendix F Survey Results of Research Needs
• Appendix G Survey Results of Research Questions

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-2007-10058-I, Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center, Chicago, IL

Suggested citation:

Noorani HZ, Adams E, Glick S, Weber S, Belinson S, Aronson N. Screening for Methicillin-Resistant Staphylococcus aureus (MRSA): Future Research Needs. Future Research Needs Paper No. 40. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 13-EHC056-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2013. www.effectivehealthcare.ahrq.gov/reports.final.cfm.

This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10058-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.

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