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In Reply: While Drs Jarvis and Muto describe the MRSA screening intervention as "selective and incomplete," the study by Harbarth et al¹ was in fact a crossover design in which screening on the intervention wards was as close to universal as can be reasonably achieved (94% of all admissions screened). The presence of geographically distinct wards that were used as contemporaneous controls strengthens rather than weakens the study. By contrast, the study by Robicsek et al² to which Jarvis and Muto refer lacked a control group and used multiple simultaneous interventions, flaws that are common to other studies that are cited in support of active surveillance and contact isolation.^3-4

Harbarth et al and Robicsek et al are difficult to compare because of differences in their conception, the patient populations, and the measured outcomes. Robicsek et al initiated universal active surveillance and decolonization in response to ongoing high rates of nosocomial . . . [Full Text of this Article]

Daniel J. Diekema, MD
Division of Infectious Diseases
University of Iowa Carver College of Medicine
Iowa City

Michael Climo, MD
michael.climo@va.gov
Division of Infectious Diseases
Hunter Holmes McGuire Veterans Affairs Medical Center
Richmond, Virginia

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Universal Screening for Methicillin-Resistant Staphylococcus aureus at Hospital Admission and Nosocomial Infection in Surgical Patients
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Universal Screening for Methicillin-Resistant Staphylococcus aureus by Hospitals
Rosemary Harris
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Universal Screening for Methicillin-Resistant Staphylococcus aureus by Hospitals
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Universal Screening for Methicillin-Resistant Staphylococcus aureus by Hospitals
William R. Jarvis and Carlene Muto
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Universal Screening for Methicillin-Resistant Staphylococcus aureus by Hospitals—Reply
Stephan Harbarth and Didier Pittet
JAMA. 2008;300(5):504-505.
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