Universal MRSA Screening at L&D: Little Benefit


From the Interscience Conference On Antimicrobial Agents And Chemotherapy

BOSTON – Active surveillance testing for methicillin-resistant Staphylococcus aureus colonization of pregnant women who were admitted to labor and delivery units costs a lot of bucks for only a little bang.

Over a 20-month period, a universal methicillin-resistant S. aureus (MRSA) screening program, required by Illinois law, cost $90,950 but had no apparent impact either on MRSA disease in the postpartum period or on nosocomial MRSA infections in a postpartum ward and newborn nursery, said Naseem Helo, a fourth-year medical student at Loyola University Medical Center in Maywood, Ill.

Among 2,254 pregnant women who were admitted to the labor and delivery unit, 1,819 (81%) received a nasal MRSA test at a cost of $50 each and 39 women (2%) screened positive, for a cost of more than $2,300 per positive screen, Mr. Helo said at the meeting, which was sponsored by the American Society for Microbiology.

Of the 39 MRSA-colonized women, 13 went on to have a cesarean section, 21 had vaginal delivery, 2 had miscarriages, and 3 were lost to follow-up because they did not deliver at the center.

When investigators looked at the effect of the positive results on practice, they found that although 9 of 13 (69%) women who had cesareans had positive test results available before the surgery, only 3 of the 9 (33%) received vancomycin prophylaxis.

“During the newborn stay, no newborns had complications of MRSA disease, and there were no nosocomial infections in our labor and delivery service, postpartum ward, and newborn nursery during the 20-month study period or 2 years prior to the study,” Mr. Helo said.

The investigators suggested that the decision to implement universal MRSA surveillance should be driven by MRSA colonization rates in specific geographic populations.

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