On March 21, the Chicago Tribune published the following letter-to-the-editor by ETC Principal Investigator Anup Malani:

“The March 18 article, "Study backs anti-infection tests of all hospital patients," (Metro) highlights an important question in the fight against the spread of deadly antibiotic-resistant superbugs and hospital-acquired infections in our nation's hospitals: is a comprehensive patient -screening program for methicillin-resistant Staphylococcus aureus (MRSA) the right strategy?

Improving hospital surveillance, reporting infections to public health departments, and infection control can help manage the emergence of antibiotic-resistant infections. The important question is which approach is best when hospitals have limited resources? Screening each patient that walks through the door is costly, and additional financial analysis is needed to determine if the benefits are greater than the costs. There may be other, more effective life-saving investments hospitals and public health departments should make. Encouraging hospitals to share information on infections, investing in better infection control in hospitals or regulating use of antibiotics by doctors are alternative strategies.

Even if comprehensive screening is cost effective, that may not be enough to get hospital to conduct such screening. If health care payers reimburse hospitals for treating MRSA infections rather than preventing them, hospitals may not find it in their financial interest to screen. The Centers for Medicare and Medicaid realize this and have reduced reimbursements for certain MRSA infections hospitals should be able to avoid. But these reforms are limited: they only apply to MRSA infections from catheters. More widespread reform of payment policy and incentives may be required to make sure hospitals find it in their best interest to reduce the cost of health care by reducing sickness.

In the long term, we need cost-effective, incentive-based policies to combat the growing threat of antibiotic resistance and preserve antibiotic effectiveness. The problem will grow larger if we fail to act