Extranasal MRSA Colonization
Medical decision makers LOVE a good systematic review. This is especially true if that review synthesizes the literature surrounding a key parameter input for their decision models. Sometimes these studies can even have clinical importance beyond informing decision-analytic models, which is the case here.
In the February 2013 ICHE, James McKinnell and colleagues completed a systematic review that estimated the incremental benefits of testing for MRSA colonization at extra-nasal sites. They combed 4,381 abstracts and 735 articles to find 23 high-quality studies comparing any-site (extranasal+nasal) screening to nasal screening for MRSA. The specifics are outlined in Table 2 below, while the overall message is that an additional one-third of patients will be detected if extranasal sites are screened. What this means as far as changing practice and the cost-effectiveness of adding extranasal sites to screening algorithms will have to wait for those future pesky decision-analytic models. Stay tuned!
Reference: Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-Resistant Staphylococcus Aureus Colonization at the Time of Hospital or Intensive Care Unit Admission James A. McKinnell, MD; Susan S. Huang, MD, MPH; Samantha J. Eells, MPH; Eric Cui, BS; Loren G. Miller, MD, MPH Infection Control and Hospital Epidemiology , Vol. 34, No. 2 (February 2013), pp. 161-170