BOSTON – Active surveillance testing for methicillin-resistant Staphylococcus aureus colonization of pregnant women who were admitted to labor and delivery units costs a lot of bucks for only a little bang, investigators reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.
Over a 20-month period, a universal methicillin-resistant S. aureus (MRSA) screening program, required by Illinois law, cost $90,950 but had no apparent impact either on MRSA disease in the postpartum period or on nosocomial MRSA infections in a postpartum ward and newborn nursery, said Naseem Helo, a fourth-year medical student at Loyola University Medical Center in Maywood, Ill.
Among 2,254 pregnant women who were admitted to the labor and delivery unit, 1,819 (81%) received a nasal MRSA test at a cost of $50 each and 39 women (2%) screened positive, for a cost of more than $2,300 per positive screen, Mr. Helo said at the meeting, which was sponsored by the American Society for Microbiology.
Of the 39 MRSA-colonized women, 13 went on to have a cesarean section, 21 had vaginal delivery, 2 had miscarriages, and 3 were lost to follow-up because they did not deliver at the center.
When the investigators looked at the effect of the positive results on practice, they found that although 9 of 13 (69%) women who had cesareans had positive test results available before the surgery, only 3 of the 9 (33%) received vancomycin prophylaxis.
When they looked at the consequence of MRSA colonization for the women, they found that one had a MRSA-positive facial abscess present on admission, and one had a possible hospital-acquired case, signaled by an indurated wound that was noticed 18 days after her cesarean section, despite her having received vancomycin prophylaxis before surgery.
“During the newborn stay, no newborns had complications of MRSA disease, and there were no nosocomial infections in our labor and delivery service, postpartum ward, and newborn nursery during the 20-month study period or 2 years prior to the study,” Mr. Helo said.
The investigators suggested that the decision to implement universal MRSA surveillance should be driven by MRSA colonization rates in specific geographic populations.
The state of Illinois in 2007 passed a public act requiring every hospital to establish a MRSA control program involving identification of all high-risk MRSA patients, isolation of colonized or infected patients, monitoring and strict enforcement of hand hygiene, and maintenance of records and reporting of cases.
In October 2007, Loyola University Medical Center started screening all patients admitted to the intensive care unit with culture of anterior nares swabs, and in November of that year instituted universal screening of all admitted patients with polymerase chain reaction (PCR) testing.
For the study, the investigators reviewed microbiology data on all positive MRSA PCR screen tests and positive MRSA cultures among women who were admitted to labor and delivery and were in postpartum wards, and among infants in the newborn nursery.
Disclosures: The Loyola University Medical Center study was internally funded. Mr. Helo said he had no conflicts of interest to disclose.