| Titre : | Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus : cluster randomised crossover trial. : Impact de tests de dépistage rapide sur l'acquisition de Staphylococcus aureus méticillino-résistant : essai transversal randomisé sur des cas groupés. (2008) |
| Auteurs : | D. JEYARATNAM ; U. AJOKU ; G.L. FRENCH ; D. LIU ; C. OREZZI ; K. PHILLIPS ; C.J. WHITTY |
| Type de document : | Article |
| Dans : | BMJ British medical journal (vol. 336, n° 7650, 2008/04) |
| Pagination : | 927-930 |
| Langues: | Anglais |
| Mots-clés : | Pharmacorésistance ; Staphylocoque ; Enquête transversale ; Colonialisme ; COLONISATION ; Infection nosocomiale ; Hygiène hospitalière ; Dépistage ; Randomisation ; Taux ; Coût |
| Résumé : | [BDSP. Notice produite par NOSOBASE oR0xHAr9. Diffusion soumise à autorisation]. OBJECTIVE : To determine whether introducing a rapid test for meticillin resistant Staphylococcus aureus (MRSA) screening leads to a reduction in MRSA acquisition on hospital general wards. DESIGN : Cluster randomised crossover trial. SETTING : Medical, surgical, elderly care, and oncology wards of a London teaching hospital on two sites. MAIN OUTCOME MEASURE : MRSA acquisition rate (proportion of patients negative for MRSA who became MRSA positive). PARTICIPANTS : All patients admitted to the study wards who were MRSA negative on admission and screened for MRSA on discharge. INTERVENTION : Rapid polymerase chain reaction based screening test for MRSA compared with conventional culture. RESULTS : Of 9608 patients admitted to study wards, 8374 met entry criteria and 6888 had full data (82.3%) ; 3335 in the control arm and 3553 in the rapid test arm. The overall MRSA carriage rate on admission was 6.7%. Rapid tests led to a reduction in median reporting time from admission, from 46 to 22 hours (P<0.001). Rapid testing also reduced the number of inappropriate pre-emptive isolation days between the control and intervention arms (399 v 277, P<0.001). This was not seen in other measurements of resource use. MRSA was acquired by 108 (3.2%) patients in the control arm and 99 (2.8%) in the intervention arm. When predefined confounding factors were taken into account the adjusted odds ratio was 0.91 (95% confidence interval 0.61 to 1.234). Rates of MRSA transmission, wound infection, and bacteraemia were not statistically different between the two arms. CONCLUSION : A rapid test for MRSA led to the quick receipt of results and had an impact on bed usage. No evidence was found of a significant reduction in MRSA acquisition and on these data it is unlikely that the increased costs of rapid tests can be justified compared with alternative control measures against MRSA. |
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