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Updated: Mar 8, 2026
Biosensor for Detection of Antibiotic Resistant Staphylococcus Bacteria
Published on: May 8, 2013
Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices: A
Melanie D Whittington1, Donna J Curtis2, Adam J Atherly3
1Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO.
Background:
To mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections, intensive care units (ICUs) conduct surveillance through screening patients upon admission followed by adhering to isolation precautions. Two surveillance approaches commonly implemented are universal preemptive isolation and targeted isolation of only MRSA-positive patients.
Methods:
Decision analysis was used to calculate the total cost of universal preemptive isolation and targeted isolation. The screening test used as part of the surveillance practice was varied to identify which screening test minimized inappropriate and total costs. A probabilistic sensitivity analysis was conducted to evaluate the range of total costs resulting from variation in inputs.
Results:
The total cost of the universal preemptive isolation surveillance practice was minimized when a polymerase chain reaction screening test was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time and thus higher isolation costs. The total cost of the targeted isolation surveillance practice was minimized when chromogenic agar 24-hour testing was used ($8.54 per patient). Costs were $22.41 more per patient when polymerase chain reaction was used.
Conclusions:
For ICUs that preemptively isolate all patients, the use of a polymerase chain reaction screening test is recommended because it can minimize total costs by reducing inappropriate isolation costs. For ICUs that only isolate MRSA-positive patients, the use of chromogenic agar 24-hour testing is recommended to minimize total costs.
Insights
For methicillin-resistant Staphylococcus aureus (MRSA) surveillance in ICUs, polymerase chain reaction screening minimizes costs for universal isolation, while 24-hour chromogenic agar testing is cost-effective for targeted isolation of MRSA-positive patients.
Area of Science:
- Infection Control and Hospital Epidemiology
- Clinical Microbiology
- Health Economics
Background:
- Intensive care units (ICUs) use surveillance and isolation precautions to mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections.
- Common strategies include universal preemptive isolation or targeted isolation of MRSA-positive patients.
Purpose of the Study:
- To compare the total costs of universal preemptive isolation versus targeted isolation strategies for MRSA surveillance in ICUs.
- To identify the most cost-effective screening test for each isolation approach.
Main Methods:
- Decision analysis was employed to calculate total costs for different surveillance and screening scenarios.
- Probabilistic sensitivity analysis was conducted to assess the impact of input variations on total costs.
Main Results:
- Universal preemptive isolation costs were minimized with polymerase chain reaction (PCR) screening ($82.51/patient), compared to conventional culture ($207.60 more/patient).
- Targeted isolation costs were minimized with 24-hour chromogenic agar testing ($8.54/patient), compared to PCR ($22.41 more/patient).
Conclusions:
- For universal preemptive isolation, PCR screening is recommended to minimize total costs by reducing inappropriate isolation expenses.
- For targeted isolation, 24-hour chromogenic agar testing is recommended to minimize overall costs.
