I am fascinated at the current nationwide trend we see in our hospitals toward precautions for methicillin resistant Staphylococcus aureus (MRSA).
Much of this trend in the United States has been sparked by last year's “present on admission” criteria from the Centers for Medicaid and Medicare Services (CMS) that limited reimbursement for the increased complexity of treating these patients if the infection was not “present on admission.”
A cottage industry in diagnostics and protective gear has emerged seemingly overnight to deal with this medical/fiscal issue. Indeed, now patients who are identified as being “carriers” of MRSA (those swabbed in the nose and other regions on admission to hospital) are branded with these scarlet letters for life.

Questions abound though. How often is the MRSA that grows out of the swab of the patient's nose the actual bug causing the infection, which led to the hospital admission? Our initial experience has been that this may be the exception rather than the rule.
While this is the case, many patients are receiving drugs to treat the MRSA while the actual infecting organism (in a foot wound for example) may get second billing. Is this good medicine? Is this good infection control practice?
We would like to hear the thoughts of others on this issue as it is a frequent topic of discussion here at the Southern Arizona Limb Salvage Alliance (SALSA).
Editor’s note: This blog entry has been adapted from its originally published form at www.diabeticfootonline.blogspot.com. It is repurposed here with permission.