Should Vascular Surgery Patients Be Screened Preoperatively for Methicillin-Resistant <i>Staphylococcus aureus</i>?

Lee, Bruce Y.; Tsui, Becky; Bailey, Rachel R.; Muder, Robert R.; Lewis, Glyn; Harrison, Lee H.

doi:10.1086/648087

Cited by 28 publications

(18 citation statements)

References 27 publications

(33 reference statements)

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“…However, this model was based on data from a hospital in Geneva, which may have lower rates of MRSA colonization than U.S. hospitals. Conversely, using data inputs from the United States, multiple studies found that MRSA screening and decolonization prior to cardiac, vascular, or orthopedic surgery or heartlung transplant was cost-effective from the third-party payer perspective and the hospital perspective (50,(157)(158)(159)(160)(161). However, Lee et al, found that screening and decolonization of pregnant women prior to cesarean delivery were not cost-effective (162).…”

Section: Economic Viabilitymentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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Section: Economic Viabilitymentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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“…In a mathematical model of the economic benefits of universal screening and decolonisation prior to vascular surgery, universal screening and decolonisation was effective at a prevalence of ≥1% and a decolonisation success rate of ≥50% [20]. Murthy et al [21] compared the costs and probability of occurrence of MRSA infection using (i) PCR screening, (ii) screening for risk factors and pre-emptive isolation and contact precautions pending chromogenic agar results and (iii) no screening in a decision analysis model.…”

Section: Active Screening Of Mrsa Carriers: Universal or Targeted?mentioning

confidence: 99%

Update on screening and clinical diagnosis of meticillin-resistant Staphylococcus aureus (MRSA)

Harbarth

Hawkey

Tenover³

et al. 2011

International Journal of Antimicrobial Agents

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“…18,62 Although the vascular and orthopedic surgery populations are similar in many ways (eg, patients tend to be older, with a median age in the mid-60s, and have comorbid conditions; and many procedures are scheduled electively rather than emergently), there are important differences. 18 As may be expected, vascular insufficiency, which can predispose patients to develop postoperative infections, is more common among vascular surgery patients.…”

Section: Discussionmentioning

confidence: 99%

“…18 As before, this model was used to compare 2 decision alternatives: the performance (by means of collecting a swab sample either from the anterior nares or from 2 body sites) or nonperformance of MRSA surveillance (this time, for an orthopedic surgery patient preparing to undergo a surgical procedure). The patient had a probability of being colonized with MRSA that was dependent on the local prevalence of MRSA and individual risk factors for colonization.…”

Section: Methodsmentioning

confidence: 99%

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The Economic Effect of Screening Orthopedic Surgery Patients Preoperatively for Methicillin-ResistantStaphylococcus aureus

Lee

Wiringa

Bailey

et al. 2010

Infect. Control Hosp. Epidemiol.

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BACKGROUND AND OBJECTIVE Patients undergoing orthopedic surgery are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections, which can result in increased morbidity, hospital lengths of stay, and medical costs. We sought to estimate the economic value of routine preoperative MRSA screening and decolonization of orthopedic surgery patients. METHODS A stochastic decision-analytic computer simulation model was used to evaluate the economic value of implementing this strategy (compared with no preoperative screening or decolonization) among orthopedic surgery patients from both the third-party payer and hospital perspectives. Sensitivity analyses explored the effects of varying MRSA colonization prevalence, the cost of screening and decolonization, and the probability of decolonization success. RESULTS Preoperative MRSA screening and decolonization was strongly cost-effective (incremental cost-effectiveness ratio less than $6,000 per quality-adjusted life year) from the third-party payer perspective even when MRSA prevalence was as low as 1%, decolonization success was as low as 25%, and decolonization costs were as high as $300 per patient. In most scenarios this strategy was economically dominant (ie, less costly and more effective than no screening). From the hospital perspective, preoperative MRSA screening and decolonization was the economically dominant strategy for all scenarios explored. CONCLUSIONS Routine preoperative screening and decolonization of orthopedic surgery patients may under many circumstances save hospitals and third-party payers money while providing health benefits.

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Should Vascular Surgery Patients Be Screened Preoperatively for Methicillin-Resistant Staphylococcus aureus?

Cited by 28 publications

References 27 publications

Decolonization in Prevention of Health Care-Associated Infections

Decolonization in Prevention of Health Care-Associated Infections

Update on screening and clinical diagnosis of meticillin-resistant Staphylococcus aureus (MRSA)

The Economic Effect of Screening Orthopedic Surgery Patients Preoperatively for Methicillin-ResistantStaphylococcus aureus

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