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Should Vascular Surgery Patients Be Screened Preoperatively for Methicillin-Resistant Staphylococcus aureus?

Published online by Cambridge University Press:  02 January 2015

Bruce Y. Lee ,
Becky Y. Tsui ,
Rachel R. Bailey ,
Kenneth J. Smith ,
Robert R. Muder ,
G. Jonathan Lewis  and
Lee H. Harrison
Bruce Y. Lee*
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Becky Y. Tsui
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Rachel R. Bailey
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Kenneth J. Smith
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania Division of Infectious Diseases, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
G. Jonathan Lewis
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
*
University of Pittsburgh, 200 Meyran Ave, Rm 217, Pittsburgh, PA 15213 (BYLl@pitt.edu)
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Abstract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infection in patients who are undergoing vascular surgical operations. Testing all vascular surgery patients preoperatively for MRSA and attempting to decolonize those who have positive results may be a strategy to prevent MRSA infection. The economic value of such a strategy has not yet been determined.

Methods.

We developed a decision-analytic computer simulation model to determine the economic value of using such a strategy before all vascular surgical procedures from the societal and third-party payer perspectives at different MRSA prevalence and decolonization success rates.

Results.

The model showed preoperative MRSA testing to be cost-effective (incremental cost-effectiveness ratio, <$50,000 per quality-adjusted life year) when the MRSA prevalence is ≥0.01 and the decolonization success rate is ≥0.25. In fact, this strategy was dominant (ie, less costly and more effective) at the following thresholds: MRSA prevalence ≥0.01 and decolonization success rate ≥0.5, and MRSA prevalence ≥0.025 and decolonization success rate ≥0.25.

Conclusion.

Testing and decolonizing patients for MRSA before vascular surgery may be a cost-effective strategy over a wide range of MRSA prevalence and decolonization success rates.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 12 , December 2009 , pp. 1158 - 1165
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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