From the Guidelines
MRSA screening is used primarily for high-risk patients in healthcare settings, particularly before high-risk operations such as cardiothoracic and orthopaedic surgery, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 1.
Key Considerations for MRSA Screening
- The decision to implement targeted screening based on a clinical risk assessment approach versus screening of all patients undergoing high-risk surgery for SA infections should be taken according to the local epidemiology, organization of work, as well as personnel and economic resources 1.
- Rapid screening for SA, including MRSA, may represent a useful tool to obtain timely results in the pre-operative assessment 1.
- Screening is typically performed for patients with a history of MRSA infection, hospitalization, and exposure to healthcare facilities within the preceding year, receipt of antibiotics within 3 months before admission, or the presence of select comorbid conditions 1.
Screening and Decolonization Protocols
- Decolonization with intranasal mupirocin with or without a chlorhexidine bath is recommended in patients colonized with S. aureus before cardiothoracic and orthopaedic surgery 1.
- The addition of vancomycin to standard prophylaxis is suggested for MRSA carriers in cardiothoracic surgery, orthopaedic surgery, and neurosurgery 1.
- A bundled approach that includes decolonization protocols plus intravenous vancomycin prophylaxis can decrease the rate of postoperative gram-positive infections, especially in high-risk patients 1.
Importance of MRSA Screening
- MRSA screening helps prevent transmission within healthcare facilities by identifying asymptomatic carriers who can then receive decolonization treatment and appropriate isolation precautions.
- This targeted approach allows for more effective infection control measures, reduces healthcare-associated MRSA infections, and promotes appropriate antibiotic stewardship by limiting unnecessary broad-spectrum antibiotic use.
From the Research
MRSA Screening Usage
MRSA screening is used in various situations, including:
- Hospital settings to identify patients colonized with MRSA, as this can help prevent the spread of the infection to other patients 2
- Before surgical procedures to reduce the risk of surgical site infections 3
- In patients with a history of MRSA infection or colonization, as they are at higher risk of developing future infections 4
- In outbreak situations to identify the source of the outbreak and prevent further transmission 2
High-Risk Patients
MRSA screening is particularly important for high-risk patients, including:
- Those with compromised immune systems 3
- Patients with chronic medical conditions, such as diabetes 3
- Patients with a history of injection drug use 3
- Patients with implantable medical devices, such as pacemakers or prosthetic joints 3
Screening Methods
MRSA screening typically involves swabbing the patient's nose, throat, and other areas of the body to collect samples for culture or molecular testing 4, 5
- The choice of screening method depends on the clinical situation and the resources available 6
- Molecular testing, such as PCR, can provide rapid results and is often used in outbreak situations 2
Treatment and Prevention
MRSA screening is an important part of a comprehensive approach to preventing and treating MRSA infections, which also includes: