Provider Alert

by Kimberly Bullock, M.D., Georgetown University Department of Family Medicine
and Providence Hospital Emergency Department
February 27, 2007

Rapid-detection test to prevent spread of MRSA

Researchers at Mayo Clinic and elsewhere are racing to develop a rapid-detection test for Staphylococcus Aureus, both to better tailor appropriate antibiotic proscribing and to halt the galloping spread of MRSA.

At the University of Maryland, patients considered at risk for MRSA can be screened in 2 HOURS with a polymerase chain reaction (PCR) DNA test developed by Becton/Dickinson & Co., rather than waiting 24-48 hours to get an answer by culturing for the bacteria. All intensive care unit patients are being screened at admission, on a weekly basis and on discharge so that infected patients can be identified and treated appropriately with isolation and precautions right away. The Becton test, which has been available since early 2006, is approved only for detecting colonization, not to guide antibiotic choices in individual patients. It requires labs to make an initial investment of more than $20,000 for a real-time PCR cycler, plus $20-$30 for each test performed!

CMS has proposed that Medicare diagnosis-related group reimbursements for nosicomial infections be STOPPED!!!!

Pressure is already on hospitals to reduce transmission of infections, but the advent of such restrictions on payments for hospital-acquired illnesses might lead some institutions to universally test patients on admission and throughout their stays. Treatment of an MRSA infection can run as much as $36,000 (PR for Becton labs). Just who pays for the tests is still a matter of debate. When a physician orders a test to pinpoint the best antibiotics to treat a patient, the cost can be charged to the patient on insurance. It isn’t clear who will bear the cost of screening hospital patients.

Take home points:
• Rapid test will be available
• This will influence screening
• Hospitals will be more aggressive in testing high-risk patients like group home/institutional patients at time of admission, so they are not blamed for nosicomial infections. The group homes will be responsible if these are positive.