mrsa decolonisation strategies cost effective in the icu

PharmacoEconomics & Outcomes News 640 - 29 Oct 2011 MRSA decolonisation strategies cost effective in the ICU According to an international group of researchers, methicillin-resistant Staphylococcus aureus (MRSA) control strategies that include decolonisation are likely to be cost effective in the intensive care unit (ICU), provided "resistance is lacking". 1 A dynamic transmission model was constructed to compare the costs * and outcomes of three screening technologies, including conventional culture, chromogenic agar and PCR ** . For each of these technologies three options were considered: no screening, universal screening or targeted screening of high-risk patients upon admission and weekly thereafter; additionally, each strategy was combined with either isolation or decolonisation (with chlorhexidine washes or nasal mupirocin). Overall, strategies that included decolonisation resulted in improved health outcomes and lower costs. Irrespective of MRSA status, universal decolonisation was the most cost effective option in the short-term; however, the researchers point out strategies that screened to target MRSA carriers "may be preferred owing to the reduced risk of selecting for resistance". Of such targeted strategies, the most cost effective was universal screening upon admission and weekly screening with PCR plus decolonisation with nasal mupirocin. Practical implications? In accompanying editorial, Professor Jan Kluytmans (of Amphia Hospital, the Netherlands) and Associate Professor, Stephen Harbarth (of the University of Geneva Hospitals and Medical School, Switzerland) say decolonisation seems an attractive strategy at first sight; however, it has some drawbacks. 2 Firstly, the number of effective agents is limited and widespread use of both chlorhexidine and mupirocin creates resistance against these agents. Secondly, there are practicality issues around administering nasal mupirocin to critically-ill patients. The results of the study "may prove to be useful, but the effectiveness of these strategies needs to be confirmed in clinical studies", conclude Professors Kluytmans and Harbarth. * from a healthcare decision maker perspective ** polymerase chain reaction 1. Robotham JV, et al. Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. BMJ 343: 13, 6 Oct 2011. Available from: URL: http:// dx.doi.org/10.1136/bmj.d5694. 2. Kluytmans J, et al. Control of MRSA in intensive care units. BMJ 343: [2], 6 Oct 2011. Available from: URL: http://dx.doi.org/10.1136/bmj.d5885. 801157992 1 PharmacoEconomics & Outcomes News 29 Oct 2011 No. 640 1173-5503/10/0640-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

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PharmacoEconomics & Outcomes News 640 - 29 Oct 2011

MRSA decolonisation strategiescost effective in the ICU

According to an international group of researchers,methicillin-resistant Staphylococcus aureus (MRSA)control strategies that include decolonisation are likelyto be cost effective in the intensive care unit (ICU),provided "resistance is lacking".1

A dynamic transmission model was constructed tocompare the costs* and outcomes of three screeningtechnologies, including conventional culture,chromogenic agar and PCR**. For each of thesetechnologies three options were considered: noscreening, universal screening or targeted screening ofhigh-risk patients upon admission and weeklythereafter; additionally, each strategy was combinedwith either isolation or decolonisation (withchlorhexidine washes or nasal mupirocin).

Overall, strategies that included decolonisationresulted in improved health outcomes and lower costs.Irrespective of MRSA status, universal decolonisationwas the most cost effective option in the short-term;however, the researchers point out strategies thatscreened to target MRSA carriers "may be preferredowing to the reduced risk of selecting for resistance". Ofsuch targeted strategies, the most cost effective wasuniversal screening upon admission and weeklyscreening with PCR plus decolonisation with nasalmupirocin.

Practical implications?In accompanying editorial, Professor Jan Kluytmans

(of Amphia Hospital, the Netherlands) and AssociateProfessor, Stephen Harbarth (of the University ofGeneva Hospitals and Medical School, Switzerland) saydecolonisation seems an attractive strategy at first sight;however, it has some drawbacks.2 Firstly, the number ofeffective agents is limited and widespread use of bothchlorhexidine and mupirocin creates resistance againstthese agents. Secondly, there are practicality issuesaround administering nasal mupirocin to critically-illpatients.

The results of the study "may prove to be useful, butthe effectiveness of these strategies needs to beconfirmed in clinical studies", conclude ProfessorsKluytmans and Harbarth.* from a healthcare decision maker perspective** polymerase chain reaction

1. Robotham JV, et al. Screening, isolation, and decolonisation strategies in thecontrol of meticillin resistant Staphylococcus aureus in intensive care units: costeffectiveness evaluation. BMJ 343: 13, 6 Oct 2011. Available from: URL: http://dx.doi.org/10.1136/bmj.d5694.

2. Kluytmans J, et al. Control of MRSA in intensive care units. BMJ 343: [2], 6Oct 2011. Available from: URL: http://dx.doi.org/10.1136/bmj.d5885.

801157992

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