Impact of different diagnostic technologies for MRSA admission screening in hospitals – a decision tree analysis

Antimicrobial Resistance and Infection Control

Claudia Hübner³  Nils-Olaf Hübner¹  Christian Wegner²  Steffen Flessa³ 

[1] IMD laboratory network, MVZ Greifswald GmbH, Greifswald, Germany

[2] Institute of Hygiene and Environmental Health, University Medicine of Greifswald, Greifswald, Germany

[3] Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, Greifswald, 17489, Germany

关键词: Methicillin-resistant Staphylococcus aureus;    Decision tree analysis;    Cost;    Hospital;    Point-of-care;    Admission screening;   

Others  :  1234767
DOI  :  10.1186/s13756-015-0093-0

 received in 2015-07-03, accepted in 2015-11-12,  发布年份 2015

【 摘 要 】

Background

Hospital infections with multiresistant bacteria, e.g., Methicillin-resistant Staphylococcus aureus (MRSA), cause heavy financial burden worldwide. Rapid and precise identification of MRSA carriage in combination with targeted hygienic management are proven to be effective but incur relevant extra costs. Therefore, health care providers have to decide which MRSA screening strategy and which diagnostic technology should be applied according to economic criteria.

Aim

The aim of this study was to determine which MRSA admission screening and infection control management strategy causes the lowest expected cost for a hospital. Focus was set on the Point-of-Care Testing (PoC).

Methods

A decision tree analytic cost model was developed, primarily based on data from peer-reviewed literature. In addition, univariate sensitivity analyses of the different input parameters were conducted to study the robustness of the results.

Findings

In the basic analysis, risk-based PoC screening showed the highest mean cost savings with 14.98 € per admission in comparison to no screening. Rapid universal screening methods became favorable at high MRSA prevalence, while in situations with low MRSA transmission rates omission of screening may be favorable.

Conclusion

Early detection of MRSA by rapid PoC or PCR technologies and consistent implementation of appropriate hygienic measures lead to high economic efficiency of MRSA management. Whether general or targeted screening is more efficient depends mainly on epidemiological and infrastructural parameters.

【 授权许可】

   
2015 Hübner et al.

【 参考文献 】

• [1]Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH et al.. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med. 2013; 173(21):1970-1978.
• [2]de Kraker ME, Davey PG, Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med. 2011; 8(10): Article ID e1001104
• [3]Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J et al.. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010; 15(41):19688.
• [4]Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol. 2005; 26(2):166-174.
• [5]ECDC. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. 2011-2012. http://ecdc. europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf webcite
• [6]Hubner C, Hubner NO, Hopert K, Maletzki S, Flessa S. Analysis of MRSA-attributed costs of hospitalized patients in Germany. Eur J Clin Microbiol Infect Dis. 2014; 33(10):1817-1822.
• [7]Polisena J, Chen S, Cimon K, McGill S, Forward K, Gardam M. Clinical effectiveness of rapid tests for methicillin resistant Staphylococcus aureus (MRSA) in hospitalized patients: a systematic review. BMC Infect Dis. 2011; 11:336. BioMed Central Full Text
• [8]Roisin S, Laurent C, Denis O, Dramaix M, Nonhoff C, Hallin M et al.. Impact of rapid molecular screening at hospital admission on nosocomial transmission of methicillin-resistant Staphylococcus aureus: cluster randomised trial. PLoS One. 2014; 9(5): Article ID e96310
• [9]Sturenburg E. Rapid detection of methicillin-resistant Staphylococcus aureus directly from clinical samples: methods, effectiveness and cost considerations. Ger Med Sci. 2009; 7:Doc06.
• [10]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(12):E582-593.
• [11]Tubbicke A, Hubner C, Hubner NO, Wegner C, Kramer A, Flessa S. Cost comparison of MRSA screening and management - a decision tree analysis. BMC Health Serv Res. 2012; 12:438. BioMed Central Full Text
• [12]Lee BY, Bailey RR, Smith KJ, Muder RR, Strotmeyer ES, Lewis GJ, et al. Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol. 2010;31(6):598–606.
• [13]KRINKO. Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute: Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014;57:696–732. [in German].
• [14]Tubbicke A, Hubner C, Kramer A, Hubner 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(10):2497-2511.
• [15]Geffers C, Barry MF. Risk of transmission of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) from patients colonized with MRSA. Infect Control Hosp Epidemiol. 2005; 26(02):114-115.
• [16]Safdar N, Marx J, Meyer NA, Maki DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control. 2006; 34(8):476-483.
• [17]Worby CJ, Jeyaratnam D, Robotham JV, Kypraios T, O'Neill PD, De Angelis D et al.. Estimating the effectiveness of isolation and decolonization measures in reducing transmission of methicillin-resistant Staphylococcus aureus in hospital general wards. Am J Epidemiol. 2013; 177(11):1306-1313.
• [18]Jernigan JA, Titus MG, Groschel DH, Getchell-White S, Farr BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol. 1996; 143(5):496-504.
• [19]Raboud J, Saskin R, Simor A, Loeb M, Green K, Low DE et al.. Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol. 2005; 26(7):607-615.
• [20]Creamer E, Galvin S, Dolan A, Sherlock O, Dimitrov BD, Fitzgerald-Hughes D et al.. Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital. Am J Infect Control. 2012; 40(5):411-415.
• [21]Buhlmann M, Bogli-Stuber K, Droz S, Muhlemann K. Rapid screening for carriage of methicillin-resistant Staphylococcus aureus by PCR and associated costs. J Clin Microbiol. 2008; 46(7):2151-2154.
• [22]Shenoy ES, Kim J, Rosenberg ES, Cotter JA, Lee H, Walensky RP et al.. Discontinuation of contact precautions for methicillin-resistant staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction. Clin Infect Dis. 2013; 57(2):176-184.
• [23]McKinnell JA, Huang SS, Eells SJ, Cui E, Miller LG. Quantifying the impact of extranasal testing of body sites for methicillin-resistant Staphylococcus aureus colonization at the time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol. 2013; 34(2):161-170.