Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T20:28:02.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Should Vascular Surgery Patients Be Screened Preoperatively for Methicillin-Resistant Staphylococcus aureus?

Published online by Cambridge University Press:  02 January 2015

Bruce Y. Lee ,
Becky Y. Tsui ,
Rachel R. Bailey ,
Kenneth J. Smith ,
Robert R. Muder ,
G. Jonathan Lewis  and
Lee H. Harrison
Bruce Y. Lee*
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Becky Y. Tsui
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Rachel R. Bailey
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Kenneth J. Smith
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania Division of Infectious Diseases, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
G. Jonathan Lewis
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
*
University of Pittsburgh, 200 Meyran Ave, Rm 217, Pittsburgh, PA 15213 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infection in patients who are undergoing vascular surgical operations. Testing all vascular surgery patients preoperatively for MRSA and attempting to decolonize those who have positive results may be a strategy to prevent MRSA infection. The economic value of such a strategy has not yet been determined.

Methods.

We developed a decision-analytic computer simulation model to determine the economic value of using such a strategy before all vascular surgical procedures from the societal and third-party payer perspectives at different MRSA prevalence and decolonization success rates.

Results.

The model showed preoperative MRSA testing to be cost-effective (incremental cost-effectiveness ratio, <$50,000 per quality-adjusted life year) when the MRSA prevalence is ≥0.01 and the decolonization success rate is ≥0.25. In fact, this strategy was dominant (ie, less costly and more effective) at the following thresholds: MRSA prevalence ≥0.01 and decolonization success rate ≥0.5, and MRSA prevalence ≥0.025 and decolonization success rate ≥0.25.

Conclusion.

Testing and decolonizing patients for MRSA before vascular surgery may be a cost-effective strategy over a wide range of MRSA prevalence and decolonization success rates.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 12 , December 2009 , pp. 1158 - 1165
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Naylor, AR, Hayes, PD, Darke, S. A prospective audit of complex wound and graft infection in Great Britain and Ireland: the emergence of MRSA. Eur J Vase Endovasc Surg 2001;21:289–294.CrossRefGoogle ScholarPubMed
2.Nasim, A, Thompson, MM, Naylor, AR, Bell, PR, London, NJ. The impact of MRSA on vascular surgery. Eur J Vase Endovasc Surg 2001;22:211–214.CrossRefGoogle ScholarPubMed
3.Chalmers, RT, Wolfe, JH, Cheshire, NJ, et al.Improved management of infrainguinal bypass graft infection with methicillin-resistant Staphylococcus aureus. Br J Surg 1999;86:1433–1436.CrossRefGoogle ScholarPubMed
4.Grimble, SA, Magee, TR, Galland, RB. Methicillin-resistant Staphylococcus aureus in patients undergoing major amputation. Eur J Vase Endovasc Surg 2001;22:215–218.CrossRefGoogle ScholarPubMed
5.Taylor, MD, Napolitano, LM. Methicillin-resistant Staphylococcus aureus infections in vascular surgery: increasing prevalence. Surg Infect (Larchmt) 2004;5:180–187.CrossRefGoogle ScholarPubMed
6.Cowie, SE, Ma, I, Lee, SK, Smith, RM, Hsiang, YN. Nosocomial MRSA infection in vascular surgery patients: impact on patient outcome. Vase Endovascular Surg 2005;39:327–334.CrossRefGoogle ScholarPubMed
7.Nather, A, Bee, CS, Huak, CY, et al.Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complications 2008;22:77–82.CrossRefGoogle ScholarPubMed
8.Richards, T, Pittathankel, AA, Purseil, R, Magee, TR, Galland, RB. MRSA in lower limb amputation and the role of antibiotic prophylaxis. J Cardiovasc Surg (Torino) 2005;46:37–41.Google ScholarPubMed
9.Murphy, GJ, Pararajasingam, R, Nasim, A, Dennis, MJ, Sayers, RD. Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients. Ann R Coll Surg Engl 2001;83:158–163.Google ScholarPubMed
10.Thompson, M. An audit demonstrating a reduction in MRSA infection in a specialised vascular unit resulting from a change in infection control protocol. Eur J Vase Endovasc Surg 2006;31:609–615.CrossRefGoogle Scholar
11.Morange-Saussier, V, Giraudeau, B, van der Mee, N, Lermusiaux, P, Quentin, R. Nasal carriage of methicillin-resistant Staphylococcus aureus in vascular surgery. Ann Vase Surg 2006;20:767–772.CrossRefGoogle ScholarPubMed
12.Bounthavong, M, Hsu, DI, Okamoto, MP. Cost-effectiveness analysis of linezolid vs vancomycin in treating methicillin-resistant Staphylococcus awreus-complicated skin and soft-tissue infections using a decision analytic model. Int J Clin Pract 2009;63:376–386.CrossRefGoogle ScholarPubMed
13.Levit, K (Thomson Reuters), Stranges, E (Thomson Reuters), Ryan, K (Thomson Reuters), Elixhauser, A (AHRQ). HCUP Facts and Figures, 2006: Statistics on Hospital-Based Care in the United States. Rockville, MD: Agency for Healthcare Research and Quality; 2008. Available at: http://www.hcup-us.ahrq.gov/reports.jsp. Accessed October 6, 1984.Google Scholar
14.Shannon, RP, Patel, B, Cummins, D, Shannon, AH, Ganguli, G, Lu, Y. Economics of central line-associated bloodstream infections. Am J Med Qual 2006;21(Suppl 6):7S–16S.CrossRefGoogle ScholarPubMed
15.Sackett, DL, Torrance, GW. The utility of different health states as perceived by the general public. J Chronic Dis 1978;31:697–704.CrossRefGoogle ScholarPubMed
16.Gold, MR, Franks, P, McCoy, KI, Fryback, DG. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care 1998;36:778–792.CrossRefGoogle ScholarPubMed
17.Tengs, TO, Wallace, A. One thousand health-related quality-of-life estimates. Med Care 2000;38:583–637.CrossRefGoogle ScholarPubMed
18.Selai, C, Rosser, R. Eliciting EuroQol descriptive data and utility scale values from inpatients: a feasibility study. Pharmacoeconomics 1995;8:147–158.CrossRefGoogle ScholarPubMed
19.Reyes, J, Hidalgo, M, Diaz, L, et al.Characterization of macrolide resistance in gram-positive cocci from Colombian hospitals: a countrywide surveillance. Int J Infect Dis 2007;11:329–336.CrossRefGoogle ScholarPubMed
20.Cerveira, JJ, Lai, BK, Padberg, FT Jr, Pappas, PJ, Hobson, RW 2nd. Methicillin-resistant Staphylococcus aureus infection does not adversely affect clinical outcome of lower extremity amputations. Ann Vase Surg 2003;17:80–85.CrossRefGoogle Scholar
21.Zack, J. Zeroing in on zero tolerance for central line-associated bacteremia. Am J Infect Control 2008;36:S176.e1-2.CrossRefGoogle Scholar
22.Bell, C, Urbach, D, Ray, J, et al.Bias in published cost effectiveness studies: systematic review. BMJ 2006;332:699–703.CrossRefGoogle ScholarPubMed
23.Shiroiwa, T, Sung, YK, Fukuda, T, Lang, HC, Bae, SC, Tsutani, K. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost-effectiveness?Health Econ 2009 [epub ahead of print].Google Scholar
24.Wilmoth, JR, Shkolnikov, V. Human mortality database. Available at: http://www.humanmortality.de. Accessed January 21, 2008.Google Scholar
25.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561–566.CrossRefGoogle ScholarPubMed
26.Graves, N, Halton, K, Lairson, D. Economics and preventing hospital-acquired infection: broadening the perspective. Infect Control Hosp Epidemiol 2007;28:178–184.CrossRefGoogle ScholarPubMed
27.Braithwaite, RS, Meitzer, DO, King, JT Jr, Leslie, D, Roberts, MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care 2008;46:349–356.CrossRefGoogle Scholar
28.Laupacis, A, Feeny, D, Detsky, AS, Tugwell, PX. How attractive does a new technology have to be to warrant adoption and utilization? tentative guidelines for using clinical and economic evaluations. CMAJ 1992;146:473–481.Google ScholarPubMed
29.Ammerlaan, HS, Kluytmans, JA, Wertheim, HF, Nouwen, JL, Bonten, MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009;48:922–930.CrossRefGoogle ScholarPubMed
30.Lautenbach, E, Nachamkin, I, Hu, B, et al.Surveillance cultures for detection of methicillin-resistant Staphylococcus aureus: diagnostic yield of anatomic sites and comparison of provider- and patient-collected samples. Infect Control Hosp Epidemiol 2009;30:380–382.CrossRefGoogle ScholarPubMed
31.Marshall, C, Spelman, D. Re: is throat screening necessary to detect methicillin-resistant Staphylococcus aureus colonization in patients upon admission to an intensive care unit? J Clin Microbiol 2007;45:3855.CrossRefGoogle Scholar