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Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis

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Title: Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis
Authors: Kardaś-Słoma, L
Lucet, J-C
Perozziello, A
Pelat, C
Birgand, G
Ruppé, E
Boëlle, P-Y
Andremont, A
Yazdanpanah, Y
Item Type: Journal Article
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 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
Issue Date: 3-Nov-2017
Date of Acceptance: 10-Aug-2017
URI: http://hdl.handle.net/10044/1/57142
DOI: https://dx.doi.org/10.1136/bmjopen-2017-017402
ISSN: 2044-6055
Publisher: BMJ Journals
Journal / Book Title: BMJ Open
Volume: 7
Issue: 11
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Publication Status: Published
Article Number: e017402
Appears in Collections:Department of Medicine (up to 2019)