Should vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus?

TitleShould vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus?
Publication TypeJournal Article
Year of Publication2009
AuthorsLee BY, Tsui BY, Bailey RR, Smith KJ, Muder RR, G Lewis J, Harrison LH
JournalInfect Control Hosp Epidemiol
Volume30
Issue12
Pagination1158-65
Date Published2009 Dec
ISSN1559-6834
KeywordsComputer Simulation, Cost-Benefit Analysis, Cross Infection, Decision Making, Computer-Assisted, Humans, Methicillin-Resistant Staphylococcus aureus, Preoperative Care, Staphylococcal Infections, Vascular Surgical Procedures
Abstract

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infection in patients who are undergoing vascular surgical operations. Testing all vascular surgery patients preoperatively for MRSA and attempting to decolonize those who have positive results may be a strategy to prevent MRSA infection. The economic value of such a strategy has not yet been determined.METHODS: We developed a decision-analytic computer simulation model to determine the economic value of using such a strategy before all vascular surgical procedures from the societal and third-party payer perspectives at different MRSA prevalence and decolonization success rates.RESULTS: The model showed preoperative MRSA testing to be cost-effective (incremental cost-effectiveness ratio, <$50,000 per quality-adjusted life year) when the MRSA prevalence is > or = 0.01 and the decolonization success rate is > or = 0.25. In fact, this strategy was dominant (ie, less costly and more effective) at the following thresholds: MRSA prevalence > or = 0.01 and decolonization success rate > or = 0.5, and MRSA prevalence > or = 0.025 and decolonization success rate > or = 0.25.CONCLUSION: Testing and decolonizing patients for MRSA before vascular surgery may be a cost-effective strategy over a wide range of MRSA prevalence and decolonization success rates.

DOI10.1086/648087
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID19852665
PubMed Central IDPMC3393849
Grant ListK24 AI052788 / AI / NIAID NIH HHS / United States
U01 GM070708 / GM / NIGMS NIH HHS / United States
U01-GM070708-05 / GM / NIGMS NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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