Study Disputes Need For Widespread Hospital Mrsa Testing

The medical community is united in its concern over the rapid spread of drug resistant staph bacteria in hospitals. But it's divided over what to do.

Some experts believe hospitals need to test large numbers of patients and isolate and treat people who prove positive, to prevent the bacteria's spread. Other experts argue this is inefficient.

Now, a new study in the Journal of the American Medical Association lends weight to the second point of view. It finds that widespread screening of patients for MRSA -- methicillin-resistant stapholoccocus aureus -- in a Swiss hospital did not reduce the number of hospital-acquired infections and wasn't cost effective.

"It wasn't what we expected. We were very surprised," said lead author Dr. Stephan Harbarth in a telephone interview Tuesday afternoon.

The results are sure to fuel an ongoing debate in the U.S. over how best to control the growing epidemic of MRSA infections, which kill nearly 19,000 people a year -- a higher death toll than AIDs, according to a much-publicized article published last October.

The debate has been roiling in Illinois, which last year became the first state to enact a law requiring hospitals to test all at-risk patients for MRSA.

The new report out of Switzerland appears to give ammunition to experts who question the value of this strategy.

The Swiss researchers screened 10,193 surgery patients admitted to the University of Geneva Hospitals between October 2004 and May 2006; a control group of more than 10,000 surgery patients was admitted without the tests.

To reduce the risk of MRSA transmission, the Geneva Hospital put patients who tested positive for the bacteria in isolation, scrubbed them with disinfectants, and gave them antibiotics.

Yet, even with all these interventions, the rates of hospital-acquired MRSA infections didn't differ significantly for the two groups, the study found.

"This is what we've been saying all long," said Kathy Warye, chief executive officer of the Association for Professionals in Infection Control and Epidemiology, a group that opposes efforts to mandate MRSA testing.

While screening patients can be a valuable, it's not a "magic wand" and it's not always the best way to deploy a medical institution's resources, said Dr. Stephen Weber, director of infection control at the University of Chicago Hospitals.

Given the results of the new study, "legislative mandates for MRSA screening are probably not appropriate," and Illinois should reconsider its new law, said Dr. Robert Weinstein, chief of infection control at Stroger Hospital.

Other experts said the Swiss study had several limitations and cautioned against interpreting its findings too broadly.

Dr. Barry Farr, a MRSA expert, noted the Swiss hospital didn't screen patients on medical wards, who probably served as a reservoir of MRSA infections within the institution and skewed the study's results.

About one-third of surgery patients at the Swiss hospital had surgery before measures could be taken to control potential MRSA infections; that may have contributed to the findings, said Dr. Karen Kaul, chair of molecular pathology at Evanston Northwestern Healthcare.

The three hospitals associated with that system -- Evanston, Glenbrook and Highland Park Hospitals -- have cut MRSA infection rates by more than half since August 2005, when they began universal screening of all newly admitted patients, she said. At Loyola University Medical Center, which began universal screening in late November, preliminary data indicates that infection rates have dropped 62 percent, said Dr. Jorge Parada, the hospitals' medical director for infection control.