The Use of Active Surveillance Cultures to Reduce Methicillin-Resistant Staphyloccocus aureus-Related Morbidity, Mortality, and Costs: A Systematic Review
Introduction Hospital-acquired infections are a frequent and serious public health problem. More than 60% of intensive care unit patients with Staphylococcus aureus have a methicillinresistant form. Active surveillance cultures (ASCs), which are universal or targeted screening cultures of patients admitted to a hospital unit, have been proposed to control the increasing numbers of infections caused by multi-drug resistant organisms. Infection control groups and policy makers have an interest in ASCs, but this method is controversial because it is unclear if it reduces morbidity and mortality and if it is cost-effective. Methods A systematic review of the literature pertaining to the use of ASCs and control of methicillin-resistant Staphylococcus aureus (MRSA) was conducted. The literature search included PubMed MEDLINE (1966- present), Web of Science (1955- present), CINAHL (1982 -present), the Cochrane Library, and a hand search of six infection control journals from 2000- 2007 and the reference lists of the included articles. Two independent reviewers selected the primary research studies to be included. Included articles were summarized and assigned quality ratings. Results Sixteen observational studies and four economic analyses were included in this systematic review. Only two of the sixteen (12.5%) observational studies had a control group. None of the studies were of high quality. No randomized controlled trials were identified. Discussion This review identified many gaps within the literature, including a need for a clear definition of ASCs, a clear implementation protocol that includes a defined screening group and laboratory methods, and rigorous economic evaluations. Existing evidence favors the use of ASCs, but the overall quality is so low that definitive recommendations cannot be made.Master of Public Healt
