• Marjan Wassenberg, Jan Kluytmans, Stephanie Erdkamp, Ron Bosboom, Anton Buiting, Erika van Elzakker, Willem Melchers, Steven Thijsen, Annet Troelstra, Christina Vandenbroucke-Grauls, Caroline Visser, Andreas Voss, Petra Wolffs, Mireille Wulf, Ton van Zwet, Ardine de Wit, and Marc Bonten.
• Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands. M.W.M.Wassenberg@umcutrecht.nl
• Crit Care. 2012 Feb 7; 16 (1): R22R22.

IntroductionPre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs).MethodsEmbedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT.ResultsA total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n=5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert).ConclusionsIn a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided.

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