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Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA)
Comparative Effectiveness Reviews, No. 102
Investigators: Susan B Glick, MD, David J Samson, MS, Elbert Huang, MD, MPH, Vikrant Vats, PhD, Stephen Weber, MD, MS, and Naomi Aronson, PhD.
Author Information and AffiliationsStructured Abstract
Objectives:
To synthesize comparative studies that examined the benefits and harms of screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage in the inpatient or outpatient setting.
Data sources:
MEDLINE®, Embase®, the Cochrane Database of Systematic Reviews, the National Institute for Clinical Excellence, the National Guideline Clearinghouse, and the Health Technology Assessment Programme were searched from January 1990 to March 2012. A search of the gray literature included databases with regulatory information, clinical trial registries, abstracts and conference papers, grants and federally funded research, and information from manufacturers.
Review methods:
We sought studies that compared MRSA screening strategies, including universal screening; screening of selected patient populations (surgery, intensive care unit, high risk); and no screening. Outcomes were MRSA acquisition; MRSA infection; morbidity (including complications of MRSA infection); mortality; adverse events (including allergic and nonallergic toxicity [e.g., hypotension], antimicrobial resistance, reduced quality of care, and medical errors); and hospital resource utilization, such as length of stay. Data were abstracted by a team of reviewers and fact-checked by another team of reviewers. Study quality was assessed using the U.S. Preventive Services Task Force framework. Strength of the body of evidence was assessed according to the Agency for Healthcare Research and Quality “Methods Guide for Effectiveness and Comparative Effectiveness Reviews.”
Results:
Forty-eight studies were abstracted for this review. Of these, only 1 was a randomized controlled trial; the other 47 studies utilized quasi-experimental study designs. Sixteen of the studies attempted to control for confounding and/or secular trends, and therefore had the potential to support causal inferences about the impact of MRSA screening on health outcomes and to contribute to the strength-of-evidence syntheses. This review found low strength of evidence that, compared with no screening, universal screening for MRSA carriage reduces healthcare-associated MRSA infection. For each of the other screening strategies evaluated, this review found insufficient evidence to determine the comparative effectiveness of screening on MRSA acquisition or infection.
Conclusions:
There is low strength of evidence that universal screening of hospital patients decreases MRSA infection. However, there is insufficient evidence on other outcomes of universal MRSA screening, including morbidity, mortality, harms, and resource utilization. There is also insufficient evidence to support or refute the effectiveness of MRSA screening on any outcomes in other settings. The available literature consisted mainly of observational studies with insufficient controls for secular trends and confounding to support causal inference, particularly because other interventions were inconsistently bundled together with MRSA screening. Future research on MRSA screening should use design features and analytic strategies addressing secular trends and confounding. Designs should also permit assessment of effects of specific bundles of screening and infection control interventions and address outcomes, including morbidity, mortality, harms, and resource utilization.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Literature Search
- Grey Literature Search
- Overview of Studies Included in the Present Review
- Key Question 1 Universal Screening for MRSA Carriage Compared With No Screening
- Key Question 2 Universal Screening for MRSA Carriage Compared With Screening of Selected Patient Populations (Targeted Screening)
- Key Question 3A Screening of ICU Patients for MRSA Carriage Compared With No Screening
- Key Question 3B Screening of Surgical Patients for MRSA Carriage Compared With No Screening
- Key Question 3C Screening of High-Risk Patients for MRSA Carriage Compared With No Screening
- Key Question 4 Screening of a Broader Patient Population for MRSA Carriage (Expanded Screening) Compared With Screening of a Narrower Patient Population (Limited Screening)
- Discussion
- Key Findings and Strength of Evidence
- Findings in Relationship to What Is Already Known
- Applicability
- Implications for Clinical and Policy Decisionmaking
- Limitations of the Comparative Effectiveness Review Process
- Limitations of the Evidence Base, Research Gaps and Future Research Opportunities
- Conclusions
- References
- Abbreviations
- Appendix A Search Strategies
- Appendix B Excluded Studies
- Appendix C MRSA Abstract and Title Screening Form
- Appendix D MRSA Full-Text Screening Form
- Appendix E MRSA Data Abstraction Form Elements
- Appendix F Data Abstraction Tables
- Appendix G Deeks’ Criteria To Assess Quality of Nonrandomized Comparative Studies
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:
Glick SB, Samson DJ, Huang E, Vats V, Weber S, Aronson N. Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA). Comparative Effectiveness Review No. 102. (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-EHC043-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 authors, 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 decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- Review Screening for methicillin-resistant Staphylococcus aureus: a comparative effectiveness review.[Am J Infect Control. 2014]Review Screening for methicillin-resistant Staphylococcus aureus: a comparative effectiveness review.Glick SB, Samson DJ, Huang ES, Vats V, Aronson N, Weber SG. Am J Infect Control. 2014 Feb; 42(2):148-55. Epub 2013 Dec 19.
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