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 extendedspectrum
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 ESBLPE.
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