Mike the Mad Biologist

MRSA and ‘Search and Destroy’


Patients with MRSA are isolated to prevent spread to other patients. In the Netherlands, hospital workers with MRSA are sent home with pay, and are treated with muriopicin nasal drops (MRSA usually lives up your nose). In addition, the workers’ family is screened along with any pets, and those that have MRSA are also treated. Because of this program, the Netherlands has kept its MRSA infection rate below one percent (in the U.S., it’s roughly 50%).

In Slate, there is a very good article about some of hurdles search-and-destroy faces in the U.S. First, some background on MRSA:

In the United States, MRSA kills an estimated 13,000 people every year, which means that a hospital patient is 10 times as likely to die of MRSA as an inmate is to be murdered in prison. The latest survey by the Centers for Disease Control and Prevention found that 64 percent of the Staphylococcus aureus strains in American hospitals were MRSA–that is, resistant to the powerful antibiotic methicillin and other antibiotics–which makes them difficult to treat….


Unfortunately, the CDC, which release new guidelines Oct. 19, hasn’t endorsed search and destroy:


The CDC refuses despite evidence to the contrary:

The Dutch approach is to test all high-risk patients before they are admitted. High risk, in practice, means diabetics, kidney-dialysis patients, and anyone who has been in a high-risk environment, such as a nursing home–or, from the point of view of the Dutch, the United States.


The primary concerns are economic:

With a few exceptions, American hospitals, for their part, have been leery of the short-term expense and staff burden posed by search and destroy. A quick nasal swab of an admitted patient may cost only $20, but the nursing staff has to carefully monitor isolated patients, and find room to house them. The hospitals’ reluctance may be shortsighted, however: A recent study showed that the average hospital infection adds $20,000 to a patient’s bill. [Mad Biologist: More recent work indicates that this is an underestimate. It's around $60,000] And while hospitals have traditionally passed on their costs to other payers, Medicare–which sets reimbursement standards–is starting to curtail payments to cover hospital errors, and may eventually stop paying to treat infections that could have been prevented.


One problem with antibiotic resistance, and hospital-acquired infections in general, is the externalization of the economic costs of resistance. Until recently, most of the incentives were based on government regulation, which was either lax or non-existant. This led to the failure to report roughly 90% of all infections. Until hospitals start paying for the costs of hospital-acquired infections–and thus the corresponding evolution of resistance due to these infections–the antibiotic resistance problem won’t get any better.

Unfortunately, this is more difficult than it sounds because how “hospital-acquired” is technically defined makes a big difference. Currently, it is defined as an infection that occurs 48 hours after admission or up to three days after discharge. Given the pervasive underreporting, one wonders how many ’47th hour’ infections we’re going to see. At least, we’re slowly moving in the right direction.



  1. #1 markie
    October 26, 2006

    it’s already evolved resistance. what makes you think it can’t evolve futher??

  2. #2 Joshua
    October 26, 2006

    Implementing these protocols is so common sensical that it hurts the brain to think that we aren’t mandating them.

  3. #3 M
    October 27, 2006

    “leery of the short-term expense and staff burden posed by search and destroy”

    And that would be why the NHS isn’t doing this either. And why just about everyone I know who has gone into hospital here has acquired MRSA while they were there (ok, its a sample size of three, but still).
