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Methicillin-resistant staphylococcus aureus nosocomial infection has a distinct epidemiological position and acts as a marker for overall hospital-acquired infection trends. Sci Rep 2022; 12:17007. [PMID: 36220870 PMCID: PMC9552150 DOI: 10.1038/s41598-022-21300-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022] Open
Abstract
An ongoing healthcare debate is whether controlling hospital-acquired infection (HAI) from methicillin-resistant Staphylococcus aureus (MRSA) will result in lowering the global HAI rate, or if MRSA will simply be replaced by another pathogen and there will be no change in overall disease burden. With surges in drug-resistant hospital-acquired pathogens during the COVID-19 pandemic, this remains an important issue. Using a dataset of more than 1 million patients in 51 acute care facilities across the USA, and with the aid of a threshold model that models the nonlinearity in outbreaks of diseases, we show that MRSA is additive to the total burden of HAI, with a distinct 'epidemiological position', and does not simply replace other microbes causing HAI. Critically, as MRSA is reduced it is not replaced by another pathogen(s) but rather lowers the overall HAI burden. The analysis also shows that control of MRSA is a benchmark for how well all non-S. aureus nosocomial infections in the same hospital are prevented. Our results are highly relevant to healthcare epidemiologists and policy makers when assessing the impact of MRSA on hospitalized patients. These findings further stress the major importance of MRSA as a unique cause of nosocomial infections, as well as its pivotal role as a biomarker in demonstrating the measured efficacy (or lack thereof) of an organization's Infection Control program.
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Kardaś-Słoma L, Fournier S, Dupont JC, Rochaix L, Birgand G, Zahar JR, Lescure FX, Kernéis S, Durand-Zaleski I, Lucet JC. Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study. Antimicrob Resist Infect Control 2022; 11:117. [PMID: 36117231 PMCID: PMC9484055 DOI: 10.1186/s13756-022-01149-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Spread of resistant bacteria causes severe morbidity and mortality. Stringent control measures can be expensive and disrupt hospital organization. In the present study, we assessed the effectiveness and cost-effectiveness of control strategies to prevent the spread of Carbapenemase-producing Enterobacterales (CPE) in a general hospital ward (GW). Methods A dynamic, stochastic model simulated the transmission of CPE by the hands of healthcare workers (HCWs) and the environment in a hypothetical 25-bed GW. Input parameters were based on published data; we assumed the prevalence at admission of 0.1%. 12 strategies were compared to the baseline (no control) and combined different prevention and control interventions: targeted or universal screening at admission (TS or US), contact precautions (CP), isolation in a single room, dedicated nursing staff (DNS) for carriers and weekly screening of contact patients (WSC). Time horizon was one year. Outcomes were the number of CPE acquisitions, costs, and incremental cost-effectiveness ratios (ICER). A hospital perspective was adopted to estimate costs, which included laboratory costs, single room, contact precautions, staff time, i.e. infection control nurse and/or dedicated nursing staff, and lost bed-days due to prolonged hospital stay of identified carriers. The model was calibrated on actual datasets. Sensitivity analyses were performed. Results The baseline scenario resulted in 0.93 CPE acquisitions/1000 admissions and costs 32,050 €/1000 admissions. All control strategies increased costs and improved the outcome. The efficiency frontier was represented by: (1) TS with DNS at a 17,407 €/avoided CPE case, (2) TS + DNS + WSC at a 30,700 €/avoided CPE case and (3) US + DNS + WSC at 181,472 €/avoided CPE case. Other strategies were dominated. Sensitivity analyses showed that TS + CP might be cost-effective if CPE carriers are identified upon admission or if the cases have a short hospital stay. However, CP were effective only when high level of compliance with hand hygiene was obtained. Conclusions Targeted screening at admission combined with DNS for identified CPE carriers with or without weekly screening were the most cost-effective options to limit the spread of CPE. These results support current recommendations from several high-income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01149-0.
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Raschpichler G, Raupach-Rosin H, Akmatov MK, Castell S, Rübsamen N, Feier B, Szkopek S, Bautsch W, Mikolajczyk R, Karch A. Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany. Sci Rep 2020; 10:17998. [PMID: 33093607 PMCID: PMC7582828 DOI: 10.1038/s41598-020-75094-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/07/2020] [Indexed: 11/09/2022] Open
Abstract
In countries with low endemic Methicillin-resistant Staphylococcus aureus (MRSA) prevalence, identification of risk groups at hospital admission is considered more cost-effective than universal MRSA screening. Predictive statistical models support the selection of suitable stratification factors for effective screening programs. Currently, there are no universal guidelines in Germany for MRSA screening. Instead, a list of criteria is available from the Commission for Hospital Hygiene and Infection Prevention (KRINKO) based on which local strategies should be adopted. We developed and externally validated a model for individual prediction of MRSA carriage at hospital admission in the region of Southeast Lower Saxony based on two prospective studies with universal screening in Braunschweig (n = 2065) and Wolfsburg (n = 461). Logistic regression was used for model development. The final model (simplified to an unweighted score) included history of MRSA carriage, care dependency and cancer treatment. In the external validation dataset, the score showed a sensitivity of 78.4% (95% CI: 64.7-88.7%), and a specificity of 70.3% (95% CI: 65.0-75.2%). Of all admitted patients, 25.4% had to be screened if the score was applied. A model based on KRINKO criteria showed similar sensitivity but lower specificity, leading to a considerably higher proportion of patients to be screened (49.5%).
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Affiliation(s)
- Gabriele Raschpichler
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Heike Raupach-Rosin
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Birgit Feier
- Central Laboratory, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Sebastian Szkopek
- Institute for Microbiology, Immunology and Hospital Hygiene, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany
| | - Wilfried Bautsch
- Institute for Microbiology, Immunology and Hospital Hygiene, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany
| | - Rafael Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Hanover Medical School, Hanover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany.
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
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Haugnes H, Elstrøm P, Kacelnik O, Jadczak U, Wisløff T, de Blasio B. Financial and temporal costs of patient isolation in Norwegian hospitals. J Hosp Infect 2020; 104:269-275. [DOI: 10.1016/j.jhin.2019.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/18/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
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Kirwin E, Varughese M, Waldner D, Simmonds K, Joffe AM, Smith S. Comparing methods to estimate incremental inpatient costs and length of stay due to methicillin-resistant Staphylococcus aureus in Alberta, Canada. BMC Health Serv Res 2019; 19:743. [PMID: 31651305 PMCID: PMC6813095 DOI: 10.1186/s12913-019-4578-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterial organism resistant to first line antibiotics. Acquisition of MRSA is often classified as either healthcare-associated or community-acquired. It has been shown that both healthcare-associated and community-acquired infections contribute to the spread of MRSA within healthcare facilities. The objective of this study was to estimate the incremental inpatient cost and length of stay for individuals colonized or infected with MRSA. Common analytical methods were compared to ensure the quality of the estimate generated. This study was performed at Alberta Ministry of Health (Edmonton, Alberta), with access to clinical MRSA data collected at two Edmonton hospitals, and ministerial administrative data holdings. Methods A retrospective cohort study of patients with MRSA was identified using a provincial infection prevention and control database. A coarsened exact matching algorithm, and two regression models (semilogarithmic ordinary least squares model and log linked generalized linear model) were evaluated. A MRSA-free cohort from the same facilities and care units was identified for the matched method; all records were used for the regression models. Records span from January 1, 2011 to December 31, 2015, for individuals 18 or older at discharge. Results Of the models evaluated, the generalized linear model was found to perform the best. Based on this model, the incremental inpatient costs associated with hospital-acquired cases were the most costly at $31,686 (14,169 – 60,158) and $47,016 (23,125 – 86,332) for colonization and infection, respectively. Community-acquired MRSA cases also represent a significant burden, with incremental inpatient costs of $7397 (2924 – 13,180) and $14,847 (8445 – 23,207) for colonization and infection, respectively. All costs are adjusted to 2016 Canadian dollars. Incremental length of stay followed a similar pattern, where hospital-acquired infections had the longest incremental stays of 35.2 (16.3–69.5) days and community-acquired colonization had the shortest incremental stays of 3.0 (0.6–6.3) days. Conclusions MRSA, and in particular, hospital-acquired MRSA, places a significant but preventable cost burden on the Alberta healthcare system. Estimates of cost and length of stay varied by the method of analysis and source of infection, highlighting the importance of selecting the most appropriate method.
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Affiliation(s)
- Erin Kirwin
- Alberta Ministry of Health, Edmonton, Alberta, Canada.
| | | | - David Waldner
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberley Simmonds
- Alberta Ministry of Health, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - A Mark Joffe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Stephanie Smith
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Touat M, Opatowski M, Brun-Buisson C, Cosker K, Guillemot D, Salomon J, Tuppin P, de Lagasnerie G, Watier L. A Payer Perspective of the Hospital Inpatient Additional Care Costs of Antimicrobial Resistance in France: A Matched Case-Control Study. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:381-389. [PMID: 30506456 PMCID: PMC6535148 DOI: 10.1007/s40258-018-0451-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Antimicrobial resistance (AMR) has become one of the biggest threats to global public health given its association with mortality, morbidity and cost of health care. However, little is known on the economic burden of hospitalization attributable to AMR from a public health insurance perspective. We assessed the excess costs to the French public health insurance system attributable to AMR infections in hospitals. METHODS Bacterial infectious disease-related hospitalizations were extracted from the National health data information system for all stays occurring in 2015. Bacterial infections, strains, and microbial resistance were identified by specific French ICD-10 codes. Information about health care expenditure, co-morbidities and demographic characteristics (i.e. gender, age) are provided. We used a matched case-control approach to determine the excess of reimbursements paid to stays with AMR compared to stays with an infection without resistance. Cases and controls were matched on gender, age, Charlson comorbidity index, category of infection, infection as principal diagnosis (two classes), microorganism and hospital status. The overall AMR cost was extrapolated to stays with AMR and excluded from the sample (multiple infections), and a second extrapolation was performed to consider stays with unknown resistance status. RESULTS The final sample included 52,921 matched-pairs (98.2% cases). Our results suggest that AMR overall cost reached EUR109.3 million in France with a mean of EUR1103 per stay; extrapolation to the entire database shows that the overall cost could potentially reach EUR287.1 million if all cases would be identified. The mean excess length of hospital stay attributable to AMR was estimated at 1.6 days. CONCLUSION AMR causes substantial cost burden in France for the public health insurance. Our study confirms the need to reinforce programs to prevent AMR infection and thereby reduce their economic burden.
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Affiliation(s)
- Mehdi Touat
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Marion Opatowski
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Christian Brun-Buisson
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Kristel Cosker
- Department of Biostatistics, Public Health Department, Medical Information, AP-HP University Hospitals Pitié Salpêtrière-Charles Foix, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Jerome Salomon
- Ministry of Social Affairs and Health, 14 Avenue Duquesne, 75350, Paris, France
| | - Philippe Tuppin
- Department of Studies on Patients and Diseases, CNAM (National Health Insurance), 50 Avenue du Professeur André Lemierre, 75986, Paris Cedex 20, France
| | - Gregoire de Lagasnerie
- Social Security Directorate, Ministry of Social Affairs and Health, 14 Avenue Duquesne, 75350, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Paris-Saclay University, 2, avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France.
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D’Agata EM, Tran D, Bautista J, Shemin D, Grima D. Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities: A Decision Analytic Model. Clin J Am Soc Nephrol 2018; 13:1389-1397. [PMID: 30139804 PMCID: PMC6140563 DOI: 10.2215/cjn.12521117] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/20/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Infections caused by multidrug-resistant organisms and Clostridium difficile are associated with substantial morbidity and mortality as well as excess costs. Antimicrobial exposure is the leading cause for these infections. Approximately 30% of antimicrobial doses administered in outpatient hemodialysis facilities are considered unnecessary. Implementing an antimicrobial stewardship program in outpatient hemodialysis facilities aimed at improving prescribing practices would have important clinical and economic benefits. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The main outcomes were total antimicrobial use, infections caused by multidrug-resistant organisms and C. difficile, infection-related mortality, and total costs. The analysis considered all patients on outpatient hemodialysis in the United States. The value of implementing antimicrobial stewardship programs, assuming a 20% decrease in unnecessary antimicrobial doses, was calculated as the incremental differences in clinical end points and cost outcomes. Event probabilities, antimicrobial regimens, and health care costs were informed by publicly available sources. RESULTS On a national level, implementation of antimicrobial stewardship programs was predicted to result in 2182 fewer infections caused by multidrug-resistant organisms and C. difficile (4.8% reduction), 629 fewer infection-related deaths (4.6% reduction), and a cost savings of $106,893,517 (5.0% reduction) per year. The model was most sensitive to clinical parameters as opposed to antimicrobial costs. CONCLUSIONS The model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.
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Affiliation(s)
| | - Diana Tran
- Cornerstone Research Group, Burlington, Ontario, Canada; and
| | - Josef Bautista
- Hypertension and Nephrology Inc., Providence, Rhode Island
| | - Douglas Shemin
- Nephrology, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada; and
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Efficacy and safety of linezolid compared with other treatments for skin and soft tissue infections: a meta-analysis. Biosci Rep 2018; 38:BSR20171125. [PMID: 29229674 PMCID: PMC5809614 DOI: 10.1042/bsr20171125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 12/01/2022] Open
Abstract
Linezolid with other treatments for skin and soft tissue infections (SSTIs) has been evaluated in several studies. However, the conclusions remain controversial. By searching PubMed, EMBASE, and Cochrane library databases, we conducted a meta-analysis to evaluate linezolid and other treatments for skin and soft tissue infections. The study was summarized, and the risk ratio (RR) and its 95% confidence interval (CI) were calculated. Eleven related articles were included in the meta-analysis. Our results revealed that linezolid was associated with a significantly better clinical (RR = 1.09, 95% CI: 1.02–1.16, Pheterogeneity = 0.326, I2 = 13.0%) and microbiological cure rates (RR = 1.08, 95% CI: 1.01–1.16, Pheterogeneity = 0.089, I2 = 41.7%) when comparing with vancomycin. There was no significant difference in the incidence of anemia, nausea, and mortality; however, the incidence of vomiting, diarrhea, and thrombocytopenia in patients treated with linezolid is significantly higher than that with other treatments. Our study confirmed that linezolid seems to be more effective than vancomycin for treating people with SSTIs. It is recommended that linezolid be monitored for thrombocytopenia, vomiting, and diarrhea. Further studies with larger dataset and well-designed models are required to validate our findings.
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Puchter L, Chaberny IF, Schwab F, Vonberg RP, Bange FC, Ebadi E. Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrob Resist Infect Control 2018; 7:1. [PMID: 29312658 PMCID: PMC5755438 DOI: 10.1186/s13756-017-0291-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022] Open
Abstract
Background Nosocomial infections due to vancomycin-resistant enterococci (VRE) have become a major problem during the last years. The purpose of this study was to investigate the economic burden of nosocomial VRE infections in a European university hospital. Methods A retrospective matched case-control study was performed including patients who acquired nosocomial infection with either VRE or vancomycin-susceptible enterococci (VSE) within a time period of 3 years. 42 cases with VRE infections and 42 controls with VSE infections were matched for age, gender, admission and discharge within the same year, time at risk for infection, Charlson comorbidity index (±1), stay on intensive care units and non-intensive care units as well as for the type of infection, using criteria of the Centers for Disease Control and Prevention. Results The median overall costs per case were significantly higher than for controls (EUR 57,675 vs. EUR 38,344; p = 0.030). Costs were similar between cases and controls before onset of infection (EUR 17,893 vs. EUR 16,600; p = 0.386), but higher after onset of infection (EUR 37,971 vs. EUR 23,025; p = 0.049). The median attributable costs per case for vancomycin-resistance were EUR 13,157 (p = 0.036). The most significant differences in costs between cases and controls turned out to be for pharmaceuticals (EUR 6030 vs. EUR 2801; p = 0.008) followed by nursing staff (EUR 8956 vs. EUR 4621; p = 0.032), medical products (EUR 3312 vs. EUR 1838; p = 0.020), and for assistant medical technicians (EUR 3766 vs. EUR 2474; p = 0.023). Furthermore, multivariate analysis revealed that costs were driven independently by vancomycin-resistance (1.4 fold; p = 0.034). Conclusions This analysis suggested that nosocomial VRE infections significantly increases hospital costs compared with VSE infections. Therefore, hospital personal should implement control measures to prevent VRE transmission.
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Affiliation(s)
- Laura Puchter
- Department of Anesthesiology and Intensive Care Medicine, KRH Klinikum Hannover, Hannover, Germany
| | - Iris Freya Chaberny
- Institute of Infection Control and Hospital Epidemiology, Leipzig University Hospital, Leipzig, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine, Berlin, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Franz-Christoph Bange
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Kardaś-Słoma L, Lucet JC, Perozziello A, Pelat C, Birgand G, Ruppé E, Boëlle PY, Andremont A, Yazdanpanah Y. Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis. BMJ Open 2017; 7:e017402. [PMID: 29102989 PMCID: PMC5722099 DOI: 10.1136/bmjopen-2017-017402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Several control strategies have been used to limit the transmission of multidrug-resistant organisms in hospitals. However, their implementation is expensive and effectiveness of interventions for the control of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) spread is controversial. Here, we aim to assess the cost-effectiveness of hospital-based strategies to prevent ESBL-PE transmission and infections. DESIGN Cost-effectiveness analysis based on dynamic, stochastic transmission model over a 1-year time horizon. PATIENTS AND SETTING Patients hospitalised in a hypothetical 10-bed intensive care unit (ICU) in a high-income country. INTERVENTIONS Base case scenario compared with (1) universal strategies (eg, improvement of hand hygiene (HH) among healthcare workers, antibiotic stewardship), (2) targeted strategies (eg, screening of patient for ESBL-PE at ICU admission and contact precautions or cohorting of carriers) and (3) mixed strategies (eg, targeted approaches combined with antibiotic stewardship). MAIN OUTCOMES AND MEASURES Cases of ESBL-PE transmission, infections, cost of intervention, cost of infections, incremental cost per infection avoided. RESULTS In the base case scenario, 15 transmissions and five infections due to ESBL-PE occurred per 100 ICU admissions, representing a mean cost of €94 792. All control strategies improved health outcomes and reduced costs associated with ESBL-PE infections. The overall costs (cost of intervention and infections) were the lowest for HH compliance improvement from 55%/60% before/after contact with a patient to 80%/80%. CONCLUSIONS Improved compliance with HH was the most cost-saving strategy to prevent the transmission of ESBL-PE. Antibiotic stewardship was not cost-effective. However, adding antibiotic restriction strategy to HH or screening and cohorting strategies slightly improved their effectiveness and may be worthy of consideration by decision-makers.
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Affiliation(s)
- Lidia Kardaś-Słoma
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Lucet
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Anne Perozziello
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Camille Pelat
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gabriel Birgand
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Etienne Ruppé
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Pierre-Yves Boëlle
- Pierre Louis Institute of Epidemiology and Public Health (IPLESPUMRS 1136), INSERM, UPMC University Paris 06, Sorbonne University, Paris, France
| | - Antoine Andremont
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
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Alfouzan W, Dhar R, Udo E. Genetic Lineages of Methicillin-Resistant Staphylococcus aureus Acquired during Admission to an Intensive Care Unit of a General Hospital. Med Princ Pract 2016; 26:113-117. [PMID: 27829243 PMCID: PMC5588361 DOI: 10.1159/000453268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objectives of this study were to determine the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection while on admission to the intensive care unit (ICU), and examine the genetic backgrounds of the MRSA isolates to establish transmission among the patients. SUBJECTS AND METHODS This study involved screening 2,429 patients admitted to the ICU of Farwania Hospital from January 2005 to October 2007 for MRSA colonization or infection. The MRSA isolates acquired after admission were investigated using a combination of molecular typing techniques to determine their genetic backgrounds. RESULTS Of 2,429 patients screened, 25 (1.0%) acquired MRSA after admission to the ICU. Of the 25 MRSA, 19 (76%) isolates belonged to health care-associated (HA-MRSA) clones: ST239-III (n = 17, 68%) and ST22-IV (n = 2, 8%). The remaining 6 MRSA isolates belonged to community-associated clones: ST80-IV (n = 3, 12%), ST97-IV (n = 2, 8%), and ST5-IV (n = 1, 4%). The ST239-III-MRSA clone was associated with infection as well as colonization, and was isolated from patients from 2005 to 2007. CONCLUSIONS The HA-MRSA clone ST239-III persistently colonized patients admitted to the ICU, indicating the possibility of its transmission among the patients over time.
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Affiliation(s)
- Wadha Alfouzan
- Microbiology Unit, Department of Laboratory Medicine, Farwania Hospital, Kuwait City, Safat, Kuwait
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Rita Dhar
- Microbiology Unit, Department of Laboratory Medicine, Farwania Hospital, Kuwait City, Safat, Kuwait
| | - Edet Udo
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Affiliation(s)
- ET Curran
- Infection Control Nurse, North Glasgow Hospitals University NHS Trust & Greater Glasgow Health Board
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13
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Farr BM. What To Think If the Results of the National Institutes of Health Randomized Trial of Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusControl Measures Are Negative (and Other Advice to Young Epidemiologists): A Review and an Au Revoir. Infect Control Hosp Epidemiol 2016; 27:1096-106. [PMID: 17006818 DOI: 10.1086/508759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 08/31/2006] [Indexed: 12/27/2022]
Abstract
The incidence of methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) infections continues to rise in National Nosocomial Infections Surveillance system hospitals, and these pathogens are reportedly causing more than 100,000 infections and many deaths each year in US healthcare facilities. This has led some to insist that control measures are now urgently needed, but several recent articles have suggested that isolation of patients does not work, is not needed, or is unsafe, or that a single cluster-randomized trial could be used to decide such matters. At least 101 studies have reported controlling MRSA infection and 38 have reported controlling VRE infection by means of active detection by surveillance culture and use of isolation for all colonized patients in healthcare settings where the pathogens are epidemic or endemic, in academic and nonacademic hospitals, and in acute care, intensive care, and long-term care settings. MRSA colonization and infection have been controlled to exceedingly low levels in multiple nations and in the state of Western Australia for decades by use of active detection and isolation. Studies suggesting problems with using such data to control MRSA colonization and infection have their own problems, which are discussed. Randomized trials are epidemiologic tools that can sometimes provide erroneous results, and they have not been considered necessary for studying isolation before it is used to control other important infections, such as tuberculosis, smallpox, and severe acute respiratory syndrome. No single epidemiologic study should be considered definitive. One should always weigh all available evidence. Infection with antibiotic-resistant pathogens such as MRSA and VRE is controllable to a low level by active detection and isolation of colonized and infected patients. Effective measures should be used to minimize the morbidity and mortality attributable to these largely preventable infections.
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Affiliation(s)
- Barry M Farr
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Raboud J, Saskin R, Simor A, Loeb M, Green K, Low DE, McGeer A. Modeling Transmission of Methicillin-ResistantStaphylococcus AureusAmong Patients Admitted to a Hospital. Infect Control Hosp Epidemiol 2016; 26:607-15. [PMID: 16092740 DOI: 10.1086/502589] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To determine the impact of the screening test, nursing workload, handwashing rates, and dependence of handwashing on risk level of patient visit on methicillin-resistantStaphylococcus aureus(MRSA) transmission among hospitalized patients.Setting:General medical ward.Methods:Monte Carlo simulation was used to model MRSA transmission (median rate per 1,000 patient-days). Visits by healthcare workers (HCWs) to patients were simulated, and MRSA was assumed to be transmitted among patients via HCWs.Results:The transmission rate was reduced from 0.89 to 0.56 by the combination of increasing the sensitivity of the screening test from 80% to 99% and being able to report results in 1 day instead of 4 days. Reducing the patient-to-nurse ratio from 4.3 in the day and 6.8 at night to 3.8 and 5.7, respectively, reduced the number of nosocomial infections from 0.89 to 0.85; reducing the ratio to 1 and 1, respectively, further reduced the number of nosocomial infections to 0.32. Increases in handwashing rates by 0%, 10%, and 20% for high-risk visits yielded reductions in nosocomial infections similar to those yielded by increases in handwashing rates for all visits (0.89, 0.36, and 0.24, respectively). Screening all patients for MRSA at admission reduced the transmission rate to 0.81 per 1,000 patient-days from 1.37 if no patients were screened.Conclusion:Within the ranges of parameters studied, the most effective strategies for reducing the rate of MRSA transmission were increasing the handwashing rates for visits involving contact with skin or bodily fluid and screening patients for MRSA at admission. (Infect Control Hosp Epidemiol 2005;26:607- 615)
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Affiliation(s)
- Janet Raboud
- Department of Public Health Sciences, University of Toronto, and University Health Network, Toronto, Ontario, Canada.
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Warren DK, Guth RM, Coopersmith CM, Merz LR, Zack JE, Fraser VJ. Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit. Infect Control Hosp Epidemiol 2016; 27:1032-40. [PMID: 17006809 DOI: 10.1086/507919] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 05/19/2006] [Indexed: 11/03/2022]
Abstract
Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.Objective.To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.Design.Prospective cohort study.Setting.Surgical ICU at a teaching hospital.Patients.All patients admitted to the surgical ICU.Results.Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).Conclusions.Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.
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Affiliation(s)
- David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, Barnes Jewish Hospital, Saint Louis, MO 63110, USA.
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Vriens MR, Blok HEM, Gigengack-Baars ACM, Mascini EM, van der Werken C, Verhoef J, Troelstra A. Methicillin-ResistantStaphylococcus AureusCarriage Among Patients After Hospital Discharge. Infect Control Hosp Epidemiol 2016; 26:629-33. [PMID: 16092743 DOI: 10.1086/502592] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground and Objective:At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.Design:All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage ofStaphylococcus aureus, and eradication treatment.Results:A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.Conclusions:Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)
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Affiliation(s)
- Menno R Vriens
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands
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Farr BM. Doing The Right Thing (and Figuring Out What That Is). Infect Control Hosp Epidemiol 2016; 27:999-1003. [PMID: 17006804 DOI: 10.1086/508672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 08/28/2006] [Indexed: 11/03/2022]
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Reed SD, Friedman JY, Engemann JJ, Griffiths RI, Anstrom KJ, Kaye KS, Stryjewski ME, Szczech LA, Reller LB, Corey GR, Schulman KA, Fowler VG. Costs and Outcomes Among Hemodialysis-Dependent Patients With Methicillin-Resistant or Methicillin-SusceptibleStaphylococcus aureusBacteremia. Infect Control Hosp Epidemiol 2016; 26:175-83. [PMID: 15756889 DOI: 10.1086/502523] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:Comorbid conditions have complicated previous analyses of the consequences of methicillin resistance for costs and outcomes ofStaphylococcus aureusbacteremia. We compared costs and outcomes of methicillin resistance in patients withS. aureusbacteremia and a single chronic condition.Design, Setting, and Patients:We conducted a prospective cohort study of hemodialysis-dependent patients with end-stage renal disease andS. aureusbacteremia hospitalized between July 1996 and August 2001. We used propensity scores to reduce bias when comparing patients with methicillin-resistant (MRSA) and methicillin-susceptible (MSSA)S. aureusbacteremia. Outcome measures were resource use, direct medical costs, and clinical outcomes at 12 weeks after initial hospitalization.Results:Fifty-four patients (37.8%) had MRSA and 89 patients (62.2%) had MSSA. Compared with patients with MSSA bacteremia, patients with MRSA bacteremia were more likely to have acquired the infection while hospitalized for another condition (27.8% vs 12.4%;P= .02). To attribute all inpatient costs toS. aureusbacteremia, we limited the analysis to 105 patients admitted for suspectedS. aureusbacteremia from a community setting. Adjusted costs were higher for MRSA bacteremia for the initial hospitalization ($21,251 vs $13,978;P= .012) and after 12 weeks ($25,518 vs $17,354;P= .015). At 12 weeks, patients with MRSA bacteremia were more likely to die (adjusted odds ratio, 5.4; 95% confidence interval, 1.5 to 18.7) than were patients with MSSA bacteremia.Conclusions:Community-dwelling, hemodialysis-dependent patients hospitalized with MRSA bacteremia face a higher mortality risk, longer hospital stays, and higher inpatient costs than do patients with MSSA bacteremia.
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Okumura LM, Riveros BS, Gomes-da-Silva MM, Veroneze I. A cost-effectiveness analysis of two different antimicrobial stewardship programs. Braz J Infect Dis 2016; 20:255-61. [PMID: 27094234 PMCID: PMC9425487 DOI: 10.1016/j.bjid.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 11/30/2022] Open
Abstract
There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective.
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Affiliation(s)
- Lucas Miyake Okumura
- Clinical Pharmacy Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Bruno Salgado Riveros
- Post Graduation Department, Pharmaceutical Sciences, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Izelandia Veroneze
- Infectious Control Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit. Infect Control Hosp Epidemiol 2015; 36:17-27. [PMID: 25627757 DOI: 10.1017/ice.2014.12] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. DESIGN Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. PATIENTS AND SETTING Hypothetical cohort of 10,000 adult patients admitted to a US intensive care unit. METHODS We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. RESULTS A total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy. CONCLUSIONS Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.
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Comprehensive review of methicillin-resistant Staphylococcus aureus: screening and preventive recommendations for plastic surgeons and other surgical health care providers. Plast Reconstr Surg 2015; 134:1078-1089. [PMID: 25347639 DOI: 10.1097/prs.0000000000000626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Up to 2.3 million people are colonized with methicillin-resistant Staphylococcus aureus in the United States, causing well-documented morbidity and mortality. Although the association of clinical outcomes with community and hospital carriage rates is increasingly defined, less is reported about asymptomatic colonization prevalence among physicians, and specifically plastic surgeons and the subsequent association with the incidence of patient surgical-site infection. METHODS A review of the literature using the PubMed and Cochrane databases analyzing provider screening, transmission, and prevalence was undertaken. In addition, a search was completed for current screening and decontamination guidelines and outcomes. RESULTS The methicillin-resistant S. aureus carriage prevalence of surgical staff is 4.5 percent. No prospective data exist regarding transmission and interventions for plastic surgeons. No studies were found specifically looking at prevalence or treatment of plastic surgeons. Current recommendations by national organizations focus on patient-oriented point-of-care testing and intervention, largely ignoring the role of the health care provider. Excellent guidelines exist regarding screening, transmission prevention, and treatment both in the workplace and in the community. No current such guidelines exist for plastic surgeons. CONCLUSIONS No Level I or II evidence was found regarding physician screening, treatment, or transmission. Current expert opinion, however, indicates that plastic surgeons and their staff should be vigilant for methicillin-resistant S. aureus transmission, and once a sentinel cluster of skin and soft-tissue infections is identified, systematic screening and decontamination should be considered. If positive, topical decolonization therapy should be offered. In refractory cases, oral antibiotic therapy may be required, but this should not be used as a first-line strategy.
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Colonization With Methicillin-Resistant Staphylococcus aureus in ICU Patients Morbidity, Mortality, and Glycopeptide Use. Infect Control Hosp Epidemiol 2015. [DOI: 10.1017/s0195941700072659] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractObjective:To determine the impact of methicillin-resis-tant Staphylococcus aureus (MRSA) colonization on the occurrence of S aureus infections (methicillin-resistant and methicillin-suscep-tible), the use of glycopeptides, and outcome among intensive care unit (ICU) patients.Design:Prospective observational cohort survey.Setting:A medical-surgical ICU with 10 single-bed rooms in a 460-bed, tertiary-care, university-affiliated hospital.Patients:A total of 1,044 ICU patients were followed for the detection of MRSA colonization from July 1, 1995, to July, 1 1998.Methods:MRSA colonization was detected using nasal samples in all patients plus wound samples in surgical patients within 48 hours of admission or within the first 48 hours of ICU stay and weekly thereafter. MRSA infections were defined using Centers for Disease Control and Prevention standard definitions, except for ventilator-associated pneumonia and catheter-related infections, which were defined by quantitative distal culture samples.Results:One thousand forty-four patients (70% medical patients) were included in the analysis. Mean age was 61±18 years; mean Simplified Acute Physiologic Score (SAPS) II was 36.4±20; and median ICU stay was 4 (range, 1-193) days. Two hundred thirty-one patients (22%) died in the ICU. Fifty-four patients (5.1%) were colonized with MRSA on admission, and 52 (4.9%) of 1,044 acquired MRSA colonization in the ICU. Thirty-five patients developed a total of 42 S aureus infections (32 MRSA, 10 methi-cillin-susceptible). After factors associated with the development of an S aureus infection were adjusted for in a multivariate Cox model (SAPS II >36: hazard ratio [HR], 1.64; P=.09; male gender: HR, 2.2; P=.05), MRSA colonization increased the risk of S aureus infection (HR, 3.84; P=.0003). MRSA colonization did not influence ICU mortality (HR, 1.01; P=.94). Glycopeptides were used in 11.4% of the patients (119/1,044) for a median duration of 5 days. For patients with no colonization, MRSA colonization on admission, and ICU-acquired MRSA colonization, respectively, glycopeptide use per 1,000 hospital days was 37.7, 235.2, and 118.3 days. MRSA colonization per se increased by 3.3-fold the use of glycopeptides in MRSA-colonized patients, even when an MRSA infection was not demonstrated, compared to non-colonized patients.Conclusions:In our unit, MRSA colonization greatly increased the risk of S aureus infection and of glycopeptide use in colonized and non-colonized patients, without influencing ICU mortality. MRSA colonization influenced glycopeptide use even if an MRSA infection was not demonstrated; thus, an MRSA control program is warranted to decrease vancomycin use and to limit glycopeptide resistance in gram-positive cocci.
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Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2015; 28:249-60. [PMID: 17326014 DOI: 10.1086/512261] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 01/05/2007] [Indexed: 01/14/2023]
Abstract
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
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Affiliation(s)
- Stephen G Weber
- Section of Infectious Diseases, University of Chicago, Chicago, IL 60637, USA.
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Boyce JM, Havill NL, Kohan C, Dumigan DG, Ligi CE. Do Infection Control Measures Work for Methicillin-ResistantStaphylococcus aureus? Infect Control Hosp Epidemiol 2015; 25:395-401. [PMID: 15188845 DOI: 10.1086/502412] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To review evidence regarding the effectiveness of control measures in reducing transmission of methicillin-resistantStaphylococcus aureus(MRSA) in hospitals.Design:Literature review and surveillance cultures of hospitalized patients at high risk for MRSA colonization or infection.Setting:A 500-bed, university-affiliated, community teaching hospital.Results:The percentage of nosocomialS. aureusinfections caused by MRSA increased significantly between 1982 and 2002, despite the use of various isolation and barrier precaution policies. The apparent ineffectiveness of control measures may be due to several factors including the failure to identify patients colonized with MRSA For example, cultures of stool specimens submitted forClostridium difficiletoxin assays at one hospital found that 12% of patients had MRSA in their stool, and 41% of patients with unrecognized colonization were cared for without using barrier precautions. Other factors include the use of barrier precaution strategies that do not account for multiple reservoirs of MRSA, poor adherence of healthcare workers (HCWs) to recommended barrier precautions and handwashing, failure to identify and treat HCWs responsible for transmitting MRSA, and importation of MRSA by patients admitted from other facilities. Control programs that include active surveillance cultures (ASCs) of high-risk patients and use of barrier precautions have reduced MRSA prevalence rates and have been cost-effective. Using a staged approach to implementing ASCs can minimize logistic problems.Conclusion:MRSA control programs are effective if they include ASCs of high-risk patients, use of barrier precautions when caring for colonized or infected patients, hand hygiene, and treating HCWs implicated in MRSA transmission.
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Affiliation(s)
- John M Boyce
- Department of Medicine, Hospital of Saint Raphael, Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511, USA
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Cummings KL, Anderson DJ, Kaye KS. Hand Hygiene Noncompliance and the Cost of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection. Infect Control Hosp Epidemiol 2015; 31:357-64. [DOI: 10.1086/651096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown.Objective.To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care.Design.Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events.Setting.Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina.Results.Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040–$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91–$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098–$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73–$57.32). A 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200-bed hospital.Conclusions.Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.
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Boyce JM. Understanding and Controlling Methicillin-ResistantStaphylococcus aureusInfections. Infect Control Hosp Epidemiol 2015; 23:485-7. [PMID: 12269442 DOI: 10.1086/502092] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Harrington G, Watson K, Bailey M, Land G, Borrell S, Houston L, Kehoe R, Bass P, Cockroft E, Marshall C, Mijch A, Spelman D. Reduction in Hospitalwide Incidence of Infection or Colonization with Methicillin-ResistantStaphylococcus aureusWith Use of Antimicrobial Hand-Hygiene Gel and Statistical Process Control Charts. Infect Control Hosp Epidemiol 2015; 28:837-44. [PMID: 17564987 DOI: 10.1086/518844] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 12/15/2006] [Indexed: 02/02/2023]
Abstract
Objective.To evaluate the impact of serial interventions on the incidence of methicillin-resistantStaphylococcus aureus(MRSA).Design.Longitudinal observational study before and after interventions.Setting.The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).Interventions.A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.Methods.Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.Results.The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P= .047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P< .001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.Conclusion.A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.
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Affiliation(s)
- Glenys Harrington
- Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Melbourne, Victoria, Australia.
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Nasal screening for MRSA: different swabs--different results! PLoS One 2014; 9:e111627. [PMID: 25353631 PMCID: PMC4213029 DOI: 10.1371/journal.pone.0111627] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Swab-based nasal screening is commonly used to identify asymptomatic carriage of Staphylococcus aureus in patients. Bacterial detection depends on the uptake and release capacities of the swabs and on the swabbing technique itself. This study investigates the performance of different swab-types in nasal MRSA-screening by utilizing a unique artificial nose model to provide realistic and standardized screening conditions. METHODS An anatomically correct artificial nose model was inoculated with a numerically defined mixture of MRSA and Staphylococcus epidermidis bacteria at quantities of 4×10(2) and 8×10(2) colony forming units (CFU), respectively. Five swab-types were tested following a strict protocol. Bacterial recovery was measured for direct plating and after elution into Amies medium by standard viable count techniques. RESULTS Mean recovered bacteria quantities varied between 209 and 0 CFU for MRSA, and 365 and 0 CFU for S. epidermidis, resulting swab-type-dependent MRSA-screening-sensitivities ranged between 0 and 100%. Swabs with nylon flocked tips or cellular foam tips performed significantly better compared to conventional rayon swabs referring to the recovered bacterial yield (p<0.001). Best results were obtained by using a flocked swab in combination with Amies preservation medium. Within the range of the utilized bacterial concentrations, recovery ratios for the particular swab-types were independent of the bacterial species. CONCLUSIONS This study combines a realistic model of a human nose with standardized laboratory conditions to analyze swab-performance in MRSA-screening situations. Therefore, influences by inter-individual anatomical differences as well as diverse colonization densities in patients could be excluded. Recovery rates vary significantly between different swab-types. The choice of the swab has a great impact on the laboratory result. In fact, the swab-type contributes significantly to true positive or false negative detection of nasal MRSA carriage. These findings should be considered when screening a patient.
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Goldsack JC, DeRitter C, Power M, Spencer A, Taylor CL, Kim SF, Kirk R, Drees M. Clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant Staphylococcus aureus positive patients admitted to medical-surgical units. Am J Infect Control 2014; 42:1039-43. [PMID: 25278390 DOI: 10.1016/j.ajic.2014.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a large and growing body of evidence that methicillin-resistant Staphylococcus aureus (MRSA) screening programs are cost effective, but such screening represents a significant cost burden for hospitals. This study investigates the clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant S aureus positive (MRSA+) patients admitted to 7 medical-surgical units of a large regional hospital, specifically to allow discontinuation of contact isolation. METHODS We conducted mixed-methods retrospective evaluation of a process improvement project that screened admitted patients with known MRSA+ status for continued MRSA colonization. RESULTS Of those eligible patients on our institution's MRSA+ list who did complete testing, 80.2% (130/162) were found to be no longer colonized, and only 19.8% (32/162) were still colonized. Forty-one percent (13/32) of interviewed patients in contact isolation for MRSA reported that isolation had affected their hospital stay, and 28% (9/32) of patients reported emotional distress resulting from their isolation. Total cost savings of the program are estimated at $101,230 per year across the 7 study units. CONCLUSION Our findings provide supporting evidence that a screening program targeting patients with a history of MRSA who would otherwise be placed in isolation has the potential to improve outcomes and patient experience and reduce costs.
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Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009. BMC Pediatr 2014; 14:121. [PMID: 24886471 PMCID: PMC4024190 DOI: 10.1186/1471-2431-14-121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Invasive methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections are major causes of numerous neonatal intensive care unit (NICU) outbreaks. There have been increasing reports of MRSA outbreaks in various neonatal intensive care units (NICUs) over the last decade. Our objective was to review the experience of Staphylococcus aureus sepsis in our NICU in the last decade and describe the trends in the incidence of Staphylococcus aureus blood stream infections from 2000 to 2009. METHODS A retrospective perinatal database review of all neonates admitted to our NICU with blood cultures positive for Staphylococcus aureus from (Jan 1st 2000 to December 31st 2009) was conducted. Infants were identified from the database and data were collected regarding their clinical characteristics and co-morbidities, including shock with sepsis and mortality. Period A represents patients admitted in 2000-2003. Period B represents patients seen in 2004-2009. RESULTS During the study period, 156/11111 infants were identified with Staphylococcus aureus blood stream infection: 41/4486 (0.91%) infants in Period A and 115/6625 (1.73%) in Period B (p < 0.0004). Mean gestation at birth was 26 weeks for infants in both periods. There were more MRSA infections in Period B (24% vs. 55% p < 0.05) and they were associated with more severe outcomes. In comparing the cases of MRSA infections observed in the two periods, infants in period B notably had significantly more pneumonia cases (2.4% vs. 27%, p = 0.0005) and a significantly higher mortality rate (0% vs. 15.7%, p = 0.0038). The incidences of skin and soft tissue infections and of necrotizing enterocolitis were not significantly changed in the two periods. CONCLUSION There was an increase in the incidence of Staphylococcus aureus infection among neonates after 2004. Although MSSA continues to be a problem in the NICU, MRSA infections were more prevalent in the past 6 years in our NICU. Increased severity of staphylococcal infections and associated rising mortality are possibly related to the increasing MRSA infections with a more virulent community-associated strain.
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Klaschik S, Lehmann LE, Steinhagen F, Book M, Molitor E, Hoeft A, Stueber F. Differentiation between Staphylococcus aureus and coagulase-negative Staphylococcus species by real-time PCR including detection of methicillin resistants in comparison to conventional microbiology testing. J Clin Lab Anal 2014; 29:122-8. [PMID: 24796889 DOI: 10.1002/jcla.21739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/12/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Staphylococcus aureus has long been recognized as a major pathogen. Methicillin-resistant strains of S. aureus (MRSA) and methicillin-resistant strains of S. epidermidis (MRSE) are among the most prevalent multiresistant pathogens worldwide, frequently causing nosocomial and community-acquired infections. METHODS In the present pilot study, we tested a polymerase chain reaction (PCR) method to quickly differentiate Staphylococci and identify the mecA gene in a clinical setting. RESULTS Compared to the conventional microbiology testing the real-time PCR assay had a higher detection rate for both S. aureus and coagulase-negative Staphylococci (CoNS; 55 vs. 32 for S. aureus and 63 vs. 24 for CoNS). Hands-on time preparing DNA, carrying out the PCR, and evaluating results was less than 5 h. CONCLUSIONS The assay is largely automated, easy to adapt, and has been shown to be rapid and reliable. Fast detection and differentiation of S. aureus, CoNS, and the mecA gene by means of this real-time PCR protocol may help expedite therapeutic decision-making and enable earlier adequate antibiotic treatment.
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Affiliation(s)
- Sven Klaschik
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
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Modeling bacterial colonization and infection routes in health care settings: Analytic and numerical approaches. J Theor Biol 2013; 334:187-99. [DOI: 10.1016/j.jtbi.2013.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 05/11/2013] [Accepted: 05/21/2013] [Indexed: 11/20/2022]
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Farbman L, Avni T, Rubinovitch B, Leibovici L, Paul M. Cost-benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review. Clin Microbiol Infect 2013; 19:E582-93. [PMID: 23991635 DOI: 10.1111/1469-0691.12280] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/12/2013] [Accepted: 05/23/2013] [Indexed: 11/30/2022]
Abstract
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37-16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025-19 170) US$ per month; median savings were 38 751 (IQR 14 206-75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with <500-beds and with interventions of >6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening.
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Affiliation(s)
- L Farbman
- Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah-Tikva, Israel; Leon Recanati Faculty of Management and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Su CH, Chang SC, Yan JJ, Tseng SH, Chien LJ, Fang CT. Excess mortality and long-term disability from healthcare-associated staphylococcus aureus infections: a population-based matched cohort study. PLoS One 2013; 8:e71055. [PMID: 23940689 PMCID: PMC3735502 DOI: 10.1371/journal.pone.0071055] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a leading cause of healthcare-associated infections (HAIs), but the impact of S. aureus HAIs on the long-term survival and functional status of hospitalized patients remain unknown. This study aimed to examine whether S. aureus HAIs increase the risks for long-term mortality and disability. METHODS We conducted a retrospective population-based matched cohort study of inpatients at 8 medical centers, 43 regional hospitals, and 63 local hospitals which participated in the Taiwan Nosocomial Infection Surveillance (TNIS). We individually matched 3070 patients with S. aureus HAIs to 6140 inpatients without HAIs at a 1∶2 ratio by age, gender, hospital, specialty, underlying diseases, and the length of stay before onset of the S. aureus HAI. Main outcome measures are one-year excess risks for mortality, new-onset chronic ventilator dependence, and new-onset dialysis-dependent end-stage renal disease. RESULTS We found that patients with S. aureus HAIs had an excess one-year mortality of 20.2% compared with matched uninfected inpatients (P<0.001). The excess risk for new-onset chronic ventilator dependence and dialysis-dependent end-stage renal disease was 7.3% and 2.6%, respectively (Ps<0.001). S. aureus HAIs were also associated with an excess hospital stay of 12 days and an extra cost of $5978 (Ps<0.001). CONCLUSION S. aureus HAIs have substantial negative effect on the long-term outcome of hospitalized patients in terms of both mortality and disability, which should be taken into consideration in future cost-effectiveness studies of the control and prevention interventions for S. aureus HAIs.
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Affiliation(s)
- Chiu-Hsia Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Fifth division, Centers for Disease Control, Taipei, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jer-Jea Yan
- Fifth division, Centers for Disease Control, Taipei, Taiwan
| | - Shu-Hui Tseng
- Fifth division, Centers for Disease Control, Taipei, Taiwan
| | - Li-Jung Chien
- Fifth division, Centers for Disease Control, Taipei, Taiwan
- * E-mail: (LJC); (CTF)
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (LJC); (CTF)
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Al Sweih N, Mokaddas E, Jamal W, Phillips OA, Rotimi VO. In VitroActivity of Linezolid and Other Antibiotics Against Gram-Positive Bacteria from the Major Teaching Hospitals in Kuwait. J Chemother 2013; 17:607-13. [PMID: 16433190 DOI: 10.1179/joc.2005.17.6.607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Multidrug-resistant Gram-positive bacteria are an increasingly pressing problem in the clinic. Consequently, linezolid, a recently introduced oxazolidinone with Gram-positive activity, was tested in comparison with 10 other antibiotics against 8103 clinically significant Gram-positive cocci by Etest, disk diffusion and Vitek methods. Linezolid demonstrated excellent activities against all isolates. Vancomycin and teicoplanin demonstrated equally excellent activity against almost all isolates. The methicillin-resistant Staphylococcus aureus (MRSA) strains were all susceptible to the glycopeptides and linezolid, but resistant to erythromycin (96%), fusidic acid (91.5%), gentamicin (84%) and clindamycin (73%). Forty one and 39% of the Streptococcus pneumoniae isolates were resistant to penicillin (MIC >0.5 microg/ml) and erythromycin (MIC >1 microg/ml), respectively. S. agalactiae susceptibility was 9% and 10% resistant to clindamycin and erythromycin, respectively. In conclusion, all the Gram-positive isolates tested were susceptible to linezolid. With its oral bioavailability profiles, it obviously holds great promise. Our data should be a useful addition to the literature from the Middle East.
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Affiliation(s)
- N Al Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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Landelle C, Pagani L, Harbarth S. Is patient isolation the single most important measure to prevent the spread of multidrug-resistant pathogens? Virulence 2013; 4:163-71. [PMID: 23302791 PMCID: PMC3654617 DOI: 10.4161/viru.22641] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Isolation or cohorting of infected patients is an old concept. Its purpose is to prevent the transmission of microorganisms from infected or colonized patients to other patients, hospital visitors, and health care workers, who may subsequently transmit them to other patients or become infected or colonized themselves. Because the process of isolating patients is expensive, time-consuming, often uncomfortable for patients and may impede care, it should be implemented only when necessary. Conversely, failure to isolate a patient with multidrug-resistant microorganisms may lead to adverse outcomes, and may ultimately be expensive when one considers the direct costs of an outbreak investigation and the indirect costs of lost productivity. In this review, we argue that contact precautions are essential to control the spread of epidemic and endemic multidrug-resistant microorganisms, and discuss limitations of some available data.
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Affiliation(s)
- Caroline Landelle
- Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
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Kyaw W, Lee L, Siong W, Ping AC, Ang B, Leo Y. Prevalence of and risk factors for MRSA colonization in HIV-positive outpatients in Singapore. AIDS Res Ther 2012; 9:33. [PMID: 23126233 PMCID: PMC3540004 DOI: 10.1186/1742-6405-9-33] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/31/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Whilst there have been studies on the risks and outcomes of MRSA colonization and infections in HIV-positive patients, local data is limited on the risk factors for MRSA colonization among these patients. We undertook this study in a tertiary HIV care centre to document the risk factors for colonization and to determine the prevalence of MRSA colonization among HIV-positive outpatients in Singapore. METHODS This was a cross-sectional study in which factors associated with MRSA positivity among patients with HIV infection were evaluated. A set of standardized questionnaire and data collection forms were available to interview all recruited patients. Following the interview, trained nurses collected swabs from the anterior nares/axilla/groin (NAG), throat and peri-anal regions. Information on demographics, clinical history, laboratory results and hospitalization history were retrieved from medical records. RESULTS MRSA was detected in swab cultures from at least 1 site in 15 patients (5.1%). Inclusion of throat and/or peri-anal swabs increased the sensitivity of NAG screening by 20%. Predictors for MRSA colonization among HIV-positive patients were age, history of pneumonia, lymphoma, presence of a percutaneous device within the past 12 months, history of household members hospitalized more than two times within the past 12 months, and a most recent CD4 count less than 200. CONCLUSIONS This study highlights that a proportion of MRSA carriers would have been undetected without multiple-site screening cultures. This study could shed insight into identifying patients at risk of MRSA colonization upon hospital visit and this may suggest that a risk factor-based approach for MRSA surveillance focusing on high risk populations could be considered.
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Halcomb EJ, Griffiths R, Fernandez R. Role of MRSA reservoirs in the acute care setting. INT J EVID-BASED HEA 2012; 6:50-77. [PMID: 21631814 DOI: 10.1111/j.1744-1609.2007.00096.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system. Objectives This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002). Search strategy A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included Medline (1966-August Week 1 2005), CINAHL (1982-August Week 1 2005), EMBASE (1996-Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005). Selection criteria All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area.
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Affiliation(s)
- Elizabeth J Halcomb
- School of Nursing, University of Western Sydney, Sydney, New South Wales, Australia, Centre for Applied Nursing Research, New South Wales Centre for Evidence-Based Health Care (a collaborating centre of the Joanna Briggs Institute), Liverpool, New South Wales, Australia
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Tübbicke A, Hübner C, Kramer A, Hübner NO, Fleßa S. Transmission rates, screening methods and costs of MRSA--a systematic literature review related to the prevalence in Germany. Eur J Clin Microbiol Infect Dis 2012; 31:2497-511. [PMID: 22573360 DOI: 10.1007/s10096-012-1632-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/30/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections represent a serious challenge for health care institutions, which is inherent in the combination of prevalence, transmission rates and costs. Furthermore, performing an MRSA screening requires information on the complex system of effectiveness, accuracy and costs of different screening methods. The purpose of this study was to give an overview of parameters with decisive significance for the burden of MRSA and the selection of a specific MRSA screening strategy. A systematic literature search for peer-reviewed health economic studies associated with MRSA was performed (from 1995 to the present). Eighty-seven different studies met all inclusion and exclusion criteria. Primary outcomes included the prevalence of MRSA, MRSA transmission rates, performance characteristics of MRSA screening methods, costs for pre-emptive isolation precautions and costs per MRSA case. The prevalence rates reported for all inpatients (1.2-5.3 %) as well as for inpatients with risk factors or patients in risk areas (3.85-20.6 %) vary greatly. The range of cross-transmission rates per day reported for patients with MRSA in isolation is 0.00081-0.009 and for carriers not in isolation is 0.00137-0.140, respectively. For polymerase chain reaction (PCR) methods, the mean sensitivity and specificity were 91.09 and 95.79 %, respectively. Culture methods show an average sensitivity of 89.01 % and an average specificity of 93.21 %. The turn-around time for PCR methods averages 15 h, while for the culture method, it can only be estimated as 48-72 h. This review filtered important parameters and cost drivers, and covered them with literature-based averages. These findings serve as an ideal evidence base for further health economic considerations of the cost-effectiveness of different MRSA screening methods.
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Affiliation(s)
- A Tübbicke
- Institute of Health Care Management, Department of Law and Economics, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany
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Leonhardt KK, Yakusheva O, Phelan D, Reeths A, Hosterman T, Bonin D, Costello M. Clinical effectiveness and cost benefit of universal versus targeted methicillin-resistant Staphylococcus aureus screening upon admission in hospitals. Infect Control Hosp Epidemiol 2012; 32:797-803. [PMID: 21768764 DOI: 10.1086/660875] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To conduct an exploratory study to evaluate the clinical effectiveness and cost benefit of universal versus targeted screening for methicillin-resistant Staphylococcus aureus (MRSA) to prevent hospital-acquired MRSA infections. DESIGN Prospective, interventional study, using a case-control design, difference-in-differences, and cost-benefit analyses. SETTING Two community hospitals in Wisconsin. PATIENTS Consecutive sample of 15,049 adult admissions from April 2009 to July 2010. INTERVENTIONS MRSA surveillance performed by polymerase chain reaction (PCR) on samples collected from all adult patients (aged over 18 years) within 30 days before or upon an admission to the hospital. During a 9-month baseline period, targeted screening was conducted at both hospitals. During the 5-month intervention period, all patients admitted to the intervention hospital were screened for MRSA. Infection control measures were consistent at both hospitals. RESULTS Universal screening was associated with an increase in admission screening of 43.58 percentage points (P< .01), an increase in MRSA detection of 2.95 percentage points (P< .01), and a small, nonsignificant decline in hospital-acquired MRSA infections of 0.12 percentage points (P< .01). The benefit-to-cost ratio was 0.50, indicating that for every dollar spent on universal versus targeted screening, only $0.50 is recovered in avoided costs of hospital-acquired MRSA infection. CONCLUSION Compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection. Universal screening was associated with higher costs of care and was not cost beneficial.
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Wassenberg M, Kluytmans J, Erdkamp S, Bosboom R, Buiting A, van Elzakker E, Melchers W, Thijsen S, Troelstra A, Vandenbroucke-Grauls C, Visser C, Voss A, Wolffs P, Wulf M, van Zwet T, de Wit A, Bonten M. Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study. Crit Care 2012; 16:R22. [PMID: 22314204 PMCID: PMC3396263 DOI: 10.1186/cc11184] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 12/21/2011] [Accepted: 02/07/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs). METHODS Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT. RESULTS A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n=5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert). CONCLUSIONS In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided.
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Affiliation(s)
- Marjan Wassenberg
- Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
- Department of Internal Medicine and Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Jan Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Molengracht 21, Breda, 4818 CK, The Netherlands
- Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
| | - Stephanie Erdkamp
- Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Ron Bosboom
- Department of Medical Microbiology, Hygiene and Infection Prevention, Slingeland Hospital, Kruisbergseweg 25, Doetinchem, 7000 AD, The Netherlands
| | - Anton Buiting
- Public Health Laboratory Tilburg, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, 5022 GC, The Netherlands
| | - Erika van Elzakker
- Department of Medical Microbiology and Infection Prevention, Haga Hospital, Leyweg 275, The Hague, 2545 CH, The Netherlands
| | - Willem Melchers
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Geert Grooteplein-Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Steven Thijsen
- Laboratory of Medical Microbiology and Immunology, Diakonessenhuis, Bosboomstraat 1, Utrecht, 3582 KE, The Netherlands
| | - Annet Troelstra
- Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Christina Vandenbroucke-Grauls
- Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, The Netherlands
| | - Caroline Visser
- Department of Medical Microbiology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Geert Grooteplein-Zuid 10, Nijmegen, 6525 GA, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, Nijmegen, 6532 SZ, The Netherlands
| | - Petra Wolffs
- Department of Medical Microbiology, CAPHRI, Maastricht University, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Mireille Wulf
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Geert Grooteplein-Zuid 10, Nijmegen, 6525 GA, The Netherlands
- Laboratory for Pathology and Medical Microbiology, PAMM Institute, De Run 6250, Veldhoven, 5504 DL, The Netherlands
| | - Ton van Zwet
- Laboratory for Medical Microbiology and Immunology, Alysis Zorggroep, Wagnerlaan 55, Arnhem, 6815 AD, The Netherlands
| | - Ardine de Wit
- National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center,Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Marc Bonten
- Department of Medical Microbiology, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center,Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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Kipp F, Köck R, Roeder N, Mellmann A. Effizientes MRSA-Management. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-011-0889-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thampi N, Morris AM. Pro/con debate: are barrier precautions cost-effective in improving patient outcomes in the intensive care unit? Crit Care 2012; 16:202. [PMID: 22264293 PMCID: PMC3396214 DOI: 10.1186/cc10532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
You are responsible for a large medical surgical ICU. Your hospital administration has been very focused on reducing rates of hospital-acquired infections particularly in the wake of increasing public attention. However, it is time for budget preparation and your financial officer is concerned about the escalating costs associated with patient isolation and barrier precautions/personal protective equipment. Having become aware of the high costs associated with these interventions, you start to wonder about the wisdom of spending so much in this area. Your hospital administration wants your direction on next year's expenditures. You are debating whether the expense is worthwhile and advise your hospital administration accordingly.
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Affiliation(s)
- Nisha Thampi
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Andrew M Morris
- Division of Infectious Diseases, Department of Medicine, Mount Sinai Hospital and University Health Network; Department of Medicine, University of Toronto; Mount Sinai Hopsital, 600 University Avenue, Suit 415, Toronto, ON M5G 1X5, Canada
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L’isolement en réanimation : intérêts, limites, perspectives. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Müller B, Becker J. HIC@RE … and its relevance for a company like RIEMSER. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2011; 6:Doc22. [PMID: 22242103 PMCID: PMC3252645 DOI: 10.3205/dgkh000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The increased incidence of infections caused by methicillin-resistant strains of Staphylococcus aureus (MRSA) burdens the healthcare systems with significant additional costs. Simple measures such as active MRSA screening can lead to a reduction of infectious events and massive savings. To establish an effective and comprehensive strategy for prevention and eradication of MRSA, the cooperation and networking of all stakeholders in the health care system is necessary. Pharmaceutical companies are part of the health care system; they therefore have a vital and ethical interest that care within the health system will be further optimized and thus continue to remain affordable. The targets of the HIC@RE project demonstrate the interests of the pharmaceutical and health-care research company RIEMSER Arzneimittel AG, so that a sufficient rationale is given for cooperation in this project.
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Affiliation(s)
- Berno Müller
- RIEMSER Arzneimittel AG, Medical Science & Operations, Greifswald – Insel Riems, Germany,*To whom correspondence should be addressed: Berno Müller, RIEMSER Arzneimittel AG, Medical Science & Operations, An der Wiek 7, 17493 Greifswald – Insel Riems, Germany, Phone: +49 (0) 38351-76-0, Fax: +49 (0) 38351-76-778, E-mail:
| | - Jürgen Becker
- RIEMSER Arzneimittel AG, Medical Science & Operations, Greifswald – Insel Riems, Germany
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Risk factors for positive admission surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in a neurocritical care unit. Crit Care Med 2011; 39:2322-9. [PMID: 21705905 DOI: 10.1097/ccm.0b013e3182227222] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hospitals are under increasing pressure to perform active surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. This study aimed to identify patients at low and high risk for positive admission surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in a neurocritical care unit using readily ascertainable historical factors. DESIGN Before/after study with nested case/control study. SETTING Neurocritical care unit of an academic hospital. PATIENTS During the intervention period (July 2007 to June 2008), after implementation of an admission surveillance culture screening program for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, 2,059 patients were admitted to the neurocritical care unit for a total of 5,957 patient days. INTERVENTIONS Cases had positive methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus admission surveillance cultures within 48 hrs of hospital admission. Controls had negative cultures. MEASUREMENTS AND MAIN RESULTS Admission surveillance cultures grew methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in 35 of 823 (4.3%) and 19 of 766 (2.5%) patients, respectively. Factors significantly associated with both methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus colonization were intravenous antibiotics and hospitalization in the past year, immunocompromised health status, intravenous drug use, long-term hemodialysis, and known prior carrier status. Transfer from an outside hospital and residence in a long-term care facility in the past year were associated with vancomycin-resistant Enterococcus colonization. Classification and regression tree analysis was used to identify variables that best predicted positive methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus surveillance cultures. A classification and regression tree model with six of these variables yielded an overall cross-validated predictive accuracy of 87.12% to detect methicillin-resistant Staphylococcus aureus colonization. For vancomycin-resistant Enterococcus, a four-variable classification and regression tree model (intravenous antibiotics, hospitalization and long-term patient care in the past year, and not being "admitted same day of procedure") optimized the predictive accuracy (94.91%). There were no cases of vancomycin-resistant Enterococcus colonization in patients admitted same day of procedure. CONCLUSIONS Colonization with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in neurocritical care patients can be predicted with a high predictive accuracy using decision trees that include four to six readily attainable risk factors. In our setting, in the absence of these risk factors and in patients admitted from home for neurosurgical procedures, routine admission surveillance cultures to the intensive care unit may not be cost-effective.
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Hitoto H, Kouatchet A, Dubé L, Lemarié C, Kempf M, Mercat A, Joly-Guillou ML, Eveillard M. Impact of screening and identifying methicillin-resistant Staphylococcus aureus carriers on hand hygiene compliance in 4 intensive care units. Am J Infect Control 2011; 39:571-6. [PMID: 21501898 DOI: 10.1016/j.ajic.2010.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 01/21/2023]
Abstract
BACKGROUND Our objective was to assess the impact of screening and identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers as a single measure in 4 intensive care units (ICUs). METHODS An evaluative study including two 6-month periods was conducted prospectively. The evaluation concerned the hand hygiene compliance (HHC) for contacts with MRSA carriers versus contacts with noncarriers (comparison C1, main objective) and for a period of absence of identification (P1) versus a period of identification (P2) (comparison C2) and MRSA cross transmission (P1 vs P2) (comparison C3) measured with 2 indicators. RESULTS Overall, 1326 opportunities of hand hygiene were observed. Concerning C1, the HHC for contacts with MRSA carriers was 42.5% versus 43.1% for contacts with noncarriers (not significant). This absence of difference was recorded whatever the ICU specialty, the category of personnel, and the nature of contacts. Concerning C2, the HHC in P1 was 44.8% versus 48.5% in P2 (not significant). Concerning C3, no significant difference was identified between the 2 periods. CONCLUSION We did not identify any advantage by using screening and identifying MRSA carriers in those 4 ICUs in which no specific strategy of additional contact measures was implemented for MRSA carriers.
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The management of infection and colonization due to methicillin-resistant Staphylococcus aureus: A CIDS/CAMM position paper. Can J Infect Dis 2011; 15:39-48. [PMID: 18159442 DOI: 10.1155/2004/531434] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is being seen with greater frequency in most hospitals and other health care facilities across Canada. The organism may cause life-threatening infections and has been associated with institutional outbreaks. Several studies have confirmed that MRSA infection is associated with increased morbidity and mortality compared with infections caused by susceptible strains, even when the presence of comorbidities is accounted for. Treatment of MRSA infection is complicated by the fact that these organisms are resistant to multiple antimicrobial agents, so treatment options are limited. The effectiveness of decolonization therapy (attempting to eradicate MRSA carriage) is also uncertain. This paper reviews the medical management of MRSA infections, discusses the potential role of decolonization and provides an overview of evidence to support recommended infection control practices.
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Nagao M, Iinuma Y, Igawa J, Saito T, Yamashita K, Kondo T, Matsushima A, Takakura S, Takaori-Kondo A, Ichiyama S. Control of an outbreak of carbapenem-resistant Pseudomonas aeruginosa in a haemato-oncology unit. J Hosp Infect 2011; 79:49-53. [PMID: 21722990 DOI: 10.1016/j.jhin.2011.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/23/2011] [Indexed: 11/16/2022]
Abstract
An outbreak of a multidrug-resistant Pseudomonas aeruginosa producing metallo-β-lactamase (MBLPA) in a haemato-oncology unit was controlled using multidisciplinary interventions. The present study assesses the effects of these interventions by active surveillance of the incidence of MBLPA infection at the 1,240-bed tertiary care Kyoto University Hospital in Kyoto, Japan. Infection control strategies in 2004 included strengthening contact precautions, analysis of risk factors for MBLPA infection and cessation of urine collection. However, new MBLPA infections were identified in 2006, which prompted enhanced environmental cleaning, routine active surveillance, and restricting carbapenem usage. Between 2004 and 2010, 17 patients in the unit became infected with indistinguishable MBLPA strains. The final five infected patients were found by routine active surveillance, but horizontal transmission was undetectable. The MBLPA outbreak in the haemato-oncology unit was finally contained in 2008.
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Affiliation(s)
- M Nagao
- Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan.
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Ho TS, Wang SM, Wu YH, Shen CF, Lin YJ, Lin CH, Liu CC. Long-term characteristics of healthcare-associated infections in a neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 43:407-15. [PMID: 21075708 DOI: 10.1016/s1684-1182(10)60064-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/26/2009] [Accepted: 08/19/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Healthcare-associated infections in neonatal intensive care units (NICUs) are associated with a significant risk of morbidity and mortality. Knowledge regarding pathogens, primary sources of infection and antibiotic resistance in the NICU is essential for developing management strategies. This study aimed to analyze the long-term characteristics of healthcare-associated infections in a tertiary referral center in southern Taiwan. METHODS Infants < 30 days old, with positive blood, cerebrospinal fluid, urine or tissue fluid cultures during hospitalization in the NICU of National Cheng Kung University Hospital from July 1989 to June 2008 were included in the study. RESULTS In total, 1,417 organisms and episodes were identified during the study period. Gram-positive organisms, Gram-negative organisms and fungi constituted 923 (65.1%), 358 (25.3%) and 136 (9.6%) of the pathogens, respectively. Of the Gram-positive organisms, coagulase-negative staphylococci (51.5%), Staphylococcus aureus (34.8%) and Enterococcus spp. (6.1%) were the major pathogens; and 27% of Staphylococcus aureus isolates were oxacillin-resistant. For the Gram-negative organisms, Klebsiella pneumoniae (22%), Pseudomonas aeruginosa (21.8%), Escherichia coli (16.7%) and Enterobacter cloacae (16.7%) were dominant. Also, Candida albicans accounted for 50% of fungal infections. The most common source of infection was bloodstream infection (59.0%), and 5.6% of these were catheter-related. Skin and soft tissue infections were also frequent (26.3%). CONCLUSION Bloodstream and skin/soft tissue infections caused by commensal species play an important role in healthcare-associated infections in the NICU. New measures should be developed in response to the changing patterns in the NICU.
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Affiliation(s)
- Tzong-Shiann Ho
- Department of Pediatrics, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
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