Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T17:33:57.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Active Surveillance and Decolonization of Methicillin-Resistant Staphylococcus aureus on Admission to Neonatal Intensive Care Units in Hong Kong: A Cost-Effectiveness Analysis

Published online by Cambridge University Press:  02 January 2015

Joyce H. S. You ,
C. Y. Chan ,
M. Y. Wong  and
Margaret Ip
Joyce H. S. You*
Affiliation:
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
C. Y. Chan
Affiliation:
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
M. Y. Wong
Affiliation:
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
Margaret Ip
Affiliation:
Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
*
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To examine potential clinical outcomes and cost of active methicillin-resistant Staphylococcus aureus (MRSA) surveillance with and without decolonization in neonatal intensive care units (NICUs) from the perspective of healthcare providers in Hong Kong.

Design.

Decision analysis modeling.

Setting.

NICU.

Patients.

Hypothetical cohort of patients admitted to an NICU.

Methods.

We designed a decision tree to simulate potential outcomes of active MRSA surveillance with and without decolonization in patients admitted to an NICU. Outcome measures included total direct medical cost per patient, MRSA infection rate, and MRSA-associated mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables.

Results.

In the base-case analysis, active surveillance plus decolonization showed a lower expected MRSA infection rate (0.911% vs 1.759%), MRSA-associated mortality rate (0.223% vs 0.431%), and total cost per patient (USD 47,294 vs USD 48,031) compared with active surveillance alone. Sensitivity analyses showed that active surveillance plus decolonization cost less and had lower event rates if the incidence risk ratio of acquiring MRSA infections in carriers after decolonization was less than 0.997. In 10,000 Monte Carlo simulations, active surveillance plus decolonization was significantly less costly than active surveillance alone 99.9% of the time, and both the MRSA infection rate and the MRSA-associated mortality rate were significantly lower 99.9% of the time.

Conclusions.

Active surveillance plus decolonization for patients admitted to NICUs appears to be cost saving and effective in reducing the MRSA infection rate and the MRSA-associated mortality rate if addition of decolonization to active surveillance reduces the risk of MRSA infection.

Infect Control Hosp Epidemiol 2012;33(10):1024-1030

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 10 , October 2012 , pp. 1024 - 1030
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Grundmann, H, Aires-de-Sousa, M, Boyce, J, Tiemersma, E. Emergence and resurgence of methicillin-resistant Staphylococcus aureus as a public-health threat. Lancet 2006;368:874–885.CrossRefGoogle ScholarPubMed
2.Kang, CI, Song, JH, Chung, DR, et al.Clinical impact of methicillin resistance on outcome of patients with Staphylococcus aureus infection: a stratified analysis according to underlying diseases and sites of infection in a large prospective cohort. J Infect 2010;61:299–306.CrossRefGoogle Scholar
3.Healy, CM, Hulten, KG, Palazzi, DL, Campbell, JR, Baker, CJ. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004; 39:1460–1466.CrossRefGoogle Scholar
4.Eckhardt, C, Halvosa, JS, Ray, SM, Blumberg, HM. Transmission of methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit from a patient with community-acquired disease. Infect Control Hosp Epidemiol 2003;24:460–461.CrossRefGoogle ScholarPubMed
5.Khoury, J, Jones, M, Grim, A, Dunne, WM Jr, Fraser, V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26: 616–621.CrossRefGoogle ScholarPubMed
6.David, MD, Kearns, AM, Gossain, S, Ganner, M, Holmes, A. Community-associated methicillin-resistant Staphylococcus aureus: nosocomial transmission in a neonatal unit. J Hosp Infect 2006; 64:244–250.CrossRefGoogle Scholar
7.Lessa, FC, Edwards, JR, Fridkin, SK, Tenover, FC, Horan, TC, Gorwitz, RJ. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995-2004. Pediatr Infect Dis J 2009;28:577–581.CrossRefGoogle ScholarPubMed
8.Huang, YC, Chou, YH, Su, LH, Lien, RI, Lin, TY. Methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in neonatal intensive care units. Pediatrics 2006;118:469–474.CrossRefGoogle ScholarPubMed
9.Gregory, ML, Eichenwald, EC, Puopolo, KM. Seven-year experience with a surveillance program to reduce methicillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit. Pediatrics 2009;123:e790–e796.CrossRefGoogle Scholar
10.Milstone, AM, Budd, A, Shepard, JW, et al.Role of decolonization in a comprehensive strategy to reduce methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit: an observational cohort study. Infect Control Hosp Epidemiol 2010;31:558–560.CrossRefGoogle Scholar
11.Maraqa, NF, Aigbivbalu, L, Masnita-Iusan, C, et al.Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control 2011;39:35–41.CrossRefGoogle Scholar
12.Song, X, Perencevich, E, Campos, J, Short, BL, Singh, N. Clinical and economic impact of methicillin-resistant Staphylococcus aureus colonization or infection on neonates in intensive care units. Infect Control Hosp Epidemiol 2010;31(2);177–182.CrossRefGoogle ScholarPubMed
13.Gerber, SI, Jones, RC, Scott, MV, et al.Management of outbreaks of methicillin-resistant Staphylococcus aureus infection in the neonatal intensive care unit: a consensus statement. Infect Control Hosp Epidemiol 2006;27:139–145.CrossRefGoogle ScholarPubMed
14.Sarda, V, Molloy, A, Kadkol, S, Janda, WM, Hershow, R, McGuinn, M. Active surveillance for methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2009;30:854–860.CrossRefGoogle ScholarPubMed
15.Schultz, ED, Tanaka, DT, Goldberg, RN, Benjamin, DK, Smith, PB. Effect of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit on total hospital cost. Infect Control Hosp Epidemiol 2009;30:383–385.CrossRefGoogle ScholarPubMed
16.Kim, YH, Chang, SS, Kim, YS, et al.Clinical outcomes in methicillin-resistant Staphylococcus aureus–colonized neonates in the neonatal intensive care unit. Neonatology 2007;91:241–247.CrossRefGoogle ScholarPubMed
17.Government of Hong Kong SAR. http://www.gov.hk. Accessed January 16, 2012.Google Scholar
18.Murfhy, A, De Angelis, G, Pittet, D, Schrenzel, J, Uckay, I, Harbarth, S. Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 2010;16:1747–1753.CrossRefGoogle Scholar
19.Olchanski, N, Mathews, C, Fusfeld, L, Jarvis, W. Assessment of the influence of test characteristics on the clinical and cost impacts of methicillin-resistant Staphylococcus aureus screening programs in US hospitals. Infect Control Hosp Epidemiol 2011; 32:250–257.CrossRefGoogle ScholarPubMed
20.Lee, BY, Bailey, RR, Smith, KJ, et al.Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 2010;31:598–606.CrossRefGoogle ScholarPubMed
21.Lee, BY, Wiringa, AE, Bailey, RR, et al.The economie effect of screening orthopedic surgery patients preoperatively for methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2010;31:1130–1138.CrossRefGoogle Scholar
22.Lee, BY, Song, Y, McGlone, SM, et al.The economic value of screening haemodialysis patients for methicillin-resistant Staphylococcus aureus in the USA. Clin Microbiol Infect 2011;17: 1717–1726.CrossRefGoogle ScholarPubMed
23.Nelson, RE, Samore, MH, Smith, KJ, Harbarth, S, Rubin, MA. Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers. Clin Microbiol Infect 2010;16: 1740–1746.CrossRefGoogle ScholarPubMed
24.Luteijn, JM, Hubben, GA, Pechlivanoglou, P, Bonten, MJ, Postma, MJ. Diagnostic accuracy of culture-based and PCR-based detection tests for methicillin-resistant Staphylococcus aureus: a meta-analysis. Clin Microbiol Infect 2011;17:146–154.CrossRefGoogle ScholarPubMed
25.Warren, DK, Liao, RS, Merz, LR, Eveland, M, Dunne, WM Jr. Detection of methicillin-resistant Staphylococcus aureus directly from nasal swab specimens by a real-time PCR assay. J Clin Microbiol 2004;42:5578–5581.CrossRefGoogle ScholarPubMed