Wednesday, March 19, 2008

Hospital tests for 'superbug' effective

Testing every hospital patient to find and treat carriers of a drug-resistant bacteria can curtail outbreaks of dangerous infections, according to a study released on Monday, but some researchers questioned whether universal screening is the solution to the problem.

The authors of the four-year study conducted in three suburban Chicago hospitals concluded that universal patient screening for methicillin-resistant Staphylococcus aureus, or MRSA, reduced infection rates by 70 percent.

But another researcher who wrote an editorial accompanying the study, which was published in the Annals of Internal Medicine, said credit for fewer illnesses could be due to better hand-washing and cleaning practices by hospital staff.

The study compared MRSA infection rates when no screening protocol was in place, to when only intensive care unit patients were tested, and to when nearly all patients were screened over a 21-month period.

Without the screening there were nearly nine new infections per 10,000 days of patient care. After universal testing was put in place, infections declined to about four per 10,000 patient-days, a 70 percent drop.

"The program we began in August of 2005 had a major patient safety impact for all our patients and demonstrated that a comprehensive effort to reduce MRSA infection can be accomplished," Dr. Lance Peterson of Evanston Northwestern Healthcare in Illinois, who worked on the study, said in a statement.

Among the authors of the study were several researchers with financial ties to Becton Dickinson & Co, a manufacturer of a test for MRSA.

Dr. Ebbing Lautenbach of the University of Pennsylvania, commenting on the study in an editorial in the journal, said it was premature to recommend universal MRSA screening.

Lautenbach said pressure on hospital staff to perform the screening consequently focused attention on following proper hygiene practices.

He also cautioned that extensive use of an antibiotic ointment to treat MRSA carriers may promote additional drug resistance. Only a few antibiotics are effective against MRSA, which is resistant to common infection-fighting medications.

As many as 1.5 percent of Americans carry MRSA, and they may spread it to others while not developing an infection themselves. Most dangerous infections occur in hospitals, where weakened patients are susceptible, and it was blamed for 19,000 U.S. deaths in 2005.

A Geneva, Switzerland, hospital study published in the Journal of the American Medical Association last week concluded universal patient screening did not curtail in-hospital MRSA infections, and found screening was costly because of the need to isolate and treat patients.

But critics of that study said the screening test used was too slow, taking nearly a day to produce results, a gap that might have allowed the contagious bug to spread.

Newer tests can identify carriers in two hours.

Monday's study credited universal screening with preventing 85 MRSA infections, Lautenbach wrote. But he suggested less costly approaches to universal screening, such as testing only at-risk patients and strict adherence to proper hygiene.

A few U.S. states have called for universal patient screening for MRSA, and some hospitals have adopted it. Hospitals face an added financial risk in October when the Medicare and Medicaid health insurance programs plan to halt reimbursements for treating hospital-acquired infections and other "preventable" conditions.


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