MRSA search & destroy: It's time to surrender

Over the past five years, we've blogged many times about active detection and isolation for MRSA (ADI, aka "search and destroy"), focusing on our doubts about its effectiveness and the stupidity of legislative mandates for this practice. Nonetheless, there remain some diehard believers. A new perspective piece in The Lancet takes another stab at analyzing the available evidence in order to guide practice. The authors focus on the large studies with the strongest designs. In a nutshell, they conclude that these studies demonstrate that ADI is either not effective or only effective as part of a bundle of interventions (i.e., combined with hand hygiene and/or MRSA decolonization). And in the case of bundles, is ADI an effective component? One study that specifically addressed this question found that ADI did not further reduce MRSA rates when added to optimizing hand hygiene compliance and chlorhexidine bathing. To provide further context the authors point out a number changes that have occurred since ADI was first touted as the best thing since sliced bread:  MRSA rates have decreased, new drugs to treat MRSA have been released, and other multidrug-resistant organisms have emerged. And then the unintended adverse consequences (fewer doctor and nurse visits, safety issues, patient dissatisfaction, anger and depression) need to be considered. The authors wisely point out that "isolation is the prototypical punishment in all societies."

This perspective piece is well reasoned and nicely summarizes a very complex topic in three pages. It should be required reading for everyone on both sides of this debate.

Photo: Paul Martinka, New York Post