Losing the MRSA label.

There are some things you might want to be for life. A credit card holder. A frequent flyer. Someone who likes to work out.Butnoonesays,“IwanttobelabeledasMRSApositive.” Methicillin-resistant Staphylococcus aureus (MRSA) leads to 250 000 hospitalizations in the US per year, and some 10 000 deaths (http://wwwnc.cdc.gov/eid/article/ 13/12/07-0629_article.htm). Moreover, it is hard to shake; in adults, 50%–60% of patients who develop a MRSA colony can carry the bacteria forward for years, even without an apparent infection. Considering the fact that MRSA is spread most commonly through healthcare facilities, it has become the scourge of modern healthcare—something everyone is on guard against. For that reason, infection control units of hospitals have policies in place to identify and isolate MRSA patients. “If you have ever been colonized with MRSA, you are branded for life a MRSA patient,” says Fred C. Tenover, vice president of scientific affairs at Cepheid, a molecular diagnostic company. Tenover has a history specializing in MRSA and other healthcareassociated infections. As someone branded with MRSA history, you receive special treatment: room isolation, doctors wear gloves, gowns, and caps, and in some cases eye and mouth protection (http://www.cdc.gov/mrsa/healthcare/clinicians/ precautions.html). Sources say that these contact precautions (CPs) can be disruptive to the quality of patient care and use up valuable physician time and hospital resources (1). “You see, the minute you go into isolation, the cost of your hospital bed could quadruple, depending on your hospital system,” says Tenover. “It is going to cost a lot more to be in that isolation room,” he says. But what if you were no longer MRSA positive? What if your body cleared the colony, but your charts didn’t reflect that? This is not an uncommon scenario. The only way to become unmarked as carrying MRSA is to undergo a series of steps that would allow for that, and those steps are tedious. Typically, it involves having 3 negative cultures over 3 days, and a treating physician with enough courage to declare a patient currently on CPs to be MRSA free. Often, healthcare stays aren’t long enough to complete the series, or, by the time the results come back, a patient has already gone home. And if it turns out that the patient is no longer MRSA positive, CPs are still used during the hospital stay. Moreover, in most places, initiating these steps is voluntary, decided by the clinician and, without national guidelines, highly variable (2). That, combined with the fact it can take years for a patient to decolonize, has allowed the label of MRSApositive to stick for life. So the question becomes whether there is an easier way to prove that someone is decolonized, thus relieving hospitals of the burden of MRSA patients and also relieving these patients whose lives change once they receive this label. As a marked patient, the minute you check into a healthcare facility, you are subject to MRSA precautions that consume resources, time, and money. Here we consider a study that suggests a practical screening method using PCR to detect MRSA patients who are no longer colonized and therefore may have their onerous CPs discontinued.