Methicillin-resistant Staphylococcus aureus in Saarland, Germany: a statewide admission prevalence screening study.

BACKGROUND: The screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA) is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed. METHODOLOGY/PRINCIPAL FINDINGS: During a four-week period, all 24 acute care hospitals of the State of Saarland participated in admission prevalence screening. Overall, 436/20,027 screened patients revealed MRSA carrier status (prevalence, 2.2/100 patients) with geriatrics and intensive care departments associated with highest prevalence (7.6/100 and 6.3/100, respectively). Risk factor analysis among 17,975 admission patients yielded MRSA history (OR, 4.3; CI₉₅ 2.7-6.8), a skin condition (OR, 3.2; CI₉₅ 2.1-5.0), and/or an indwelling catheter (OR, 2.2; CI₉₅ 1.4-3.5) among the leading risks. Hierarchical risk factor ascertainment of the six risk factors associated with highest odd's ratios would require 31% of patients to be laboratory screened to allow for detection of 67% of all MRSA positive admission patients in the State. CONCLUSIONS/SIGNIFICANCE: State-wide admission prevalence screening in conjunction with risk factor ascertainment yields important information on the distribution of the MRSA burden for hospitals, and allows for data-based decisions on local or institutional MRSA screening policies considering risk factor prevalence and expected MRSA identification rates

Univariate analysis of risk factors associated with MRSA carriership upon admission and conditional logistic regression (only significant risk factors depicted in the table).

<p>Risk factors are listed according to OR values of univariate analysis. For detailed description of the risk factors ascertained, please refer to Methods.</p>*<p> = P<0.05.</p

MRSA admission prevalence according to medical specialty.

<p>MRSA admission prevalence according to medical specialty.</p

Cumulative proportions of patients reporting one or several risk factors and resulting number-to-screen (applying risk factors significant in conditional logistic regression analysis, see Table 2).

<p>Cumulative proportions of patients reporting one or several risk factors and resulting number-to-screen (applying risk factors significant in conditional logistic regression analysis, see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0073876#pone-0073876-t002" target="_blank">Table 2</a>).</p