Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures
Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures
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DOI：
10.1016/j.jhin.2016.02.013
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发表时间：
2016-06-01
影响因子：
6.9
通讯作者：
Mischnik, A.
中科院分区：
文献类型：
--
作者：
Mutters, N. T.;Guenther, F.;Mischnik, A.
背景：多药耐药菌(MDRO)是一种经济负担，感染控制(IC)措施是成本和劳动力密集型的。为了有效利用有限的资源，制定了包括主动筛选在内的两级IC管理战略。简而言之，根据MDRO的类型将高危患者与其他患者区分开来，并相应地实施IC措施。目的：评估这种IC管理策略的成本和收益。所有高危患者都接受了微生物筛查。革兰氏阴性菌(GNB)分为多重耐药(MDR)和广泛耐药(XDR)。费用包括人员、材料、实验室、增加的工作量和职业成本。结果：总共筛查了39,551名患者，占所有入院患者的24.5%。在所有筛查的患者中，有7.8%(N=3,104)MDRO阳性，这些患者主要以万古霉素耐药肠球菌为主(37.3%)，其次是耐甲氧西林金黄色葡萄球菌(30.3%)和耐多药耐药金黄色葡萄球菌(28.3%)。所有患者的中位住院时间(LOS)为10天(四分位数范围为3-20)；定居患者的中位住院时间是后者的两倍(P<；0.001)。筛查成本总计255,093.82(原文如此)，IC措施成本97,701.36(原文如此)，机会成本599,225.52(原文如此)。这一IC管理策略总共节省了500,941.84(原文如此)。未检测到的携带者的可能传播将导致613,648.90-4,974,939.26(原文如此)的额外成本(即约600,000-500万(原文原文如此))。结论：尽管包括主动微生物筛查在内的两级IC管理策略的成本并不是微不足道的，但这些数据表明，当防止传播包括在成本估计中时，该方法是具有成本效益的。(C)2016年医疗感染学会。爱思唯尔有限公司出版。保留所有权利。
Background: Multidrug-resistant organisms (MDROs) are an economic burden, and infection control (IC) measures are cost-and labour-intensive. A two-tier IC management strategy was developed, including active screening, in order to achieve effective use of limited resources. Briefly, high-risk patients were differentiated from other patients, distinguished according to type of MDRO, and IC measures were implemented accordingly.Aim: To evaluate costs and benefits of this IC management strategy.Methods: The study period comprised 2.5 years. All high-risk patients underwent microbiological screening. Gram-negative bacteria (GNB) were classified as multidrug-resistant (MDR) and extensively drug-resistant (XDR). Expenses consisted of costs for staff, materials, laboratory, increased workload and occupational costs.Findings: In total, 39,551 patients were screened, accounting for 24.5% of all admissions. Of all screened patients, 7.8% (N = 3,104) were MDRO positive; these patients were mainly colonized with vancomycin-resistant enterococci (37.3%), followed by meticillin-resistant Staphylococcus aureus (30.3%) and MDR-GNB (28.3%). The median length of stay (LOS) for all patients was 10 days (interquartile range 3-20); LOS was twice as long in colonized patients (P < 0.001). Screening costs totalled 255,093.82(sic), IC measures cost 97,701.36(sic), and opportunity costs were 599,225.52(sic). The savings of this IC management strategy totalled 500,941.84(sic). Possible transmissions by undetected carriers would have caused additional costs of 613,648.90-4,974,939.26(sic) (i.e. approximately 600,000-5 million (sic)).Conclusion: Although the costs of a two-tier IC management strategy including active microbiological screening are not trivial, these data indicate that the approach is cost-effective when prevented transmissions are included in the cost estimate. (C) 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.