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Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years’ Experience

Published online by Cambridge University Press:  26 May 2015

H. M. Gebreselassie
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
T. Kaspar
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
S. Droz
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
J. Marschall
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland



To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy.


Screening study and cost-effectiveness analysis.


Analysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate).


There were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548).


In an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.

Infect. Control Hosp. Epidemiol. 2015;36(9):1046–1049

Original Articles
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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