Oosterheert J J, Bonten M J M, Buskens E, Schneider M M E, Hoepelman I M
Department of Emergency Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Clin Microbiol. 2003 Oct;41(10):4708-13. doi: 10.1128/JCM.41.10.4708-4713.2003.
A rapid diagnosis of pneumococcal pneumonia may allow the earlier use of narrow-spectrum antimicrobial therapy. It is unknown, however, whether rapid diagnostic testing of patients hospitalized with community-acquired pneumonia (CAP) admitted to hospital lowers costs. Therefore, an algorithm to calculate the costs associated with the diagnosis and treatment of CAP was formulated. Subsequently, the algorithm was applied to clinical data for 122 consecutively admitted patients with CAP whose sputum samples were Gram stained and whose urine was tested for Streptococcus pneumoniae antigen. The costs of initial antimicrobial therapy, personnel, and materials were measured. Compared to the most expensive empirical regimen, rapid diagnostic testing would result in cost savings per patient (PP) of 3.51 Euros for Gram staining and 8.11 Euros for urinary pneumococcal antigen testing (1 Euro is equal to 1.13 US dollars, from 2000 to 2002). Compared to the cheapest regimen, Gram staining would increase the cost by 2.25 Euros PP, and urinary antigen testing would increase the cost by 24.26 Euros PP. In our setting, the use of rapid diagnostic testing would not lower costs. Cost savings depend, however, on the differences in the prices of the different antibiotics chosen and the proportion of evaluable and positive samples.
肺炎球菌肺炎的快速诊断可能有助于更早使用窄谱抗菌治疗。然而，对于因社区获得性肺炎（CAP）住院的患者进行快速诊断检测是否能降低成本尚不清楚。因此，制定了一种算法来计算与CAP诊断和治疗相关的成本。随后，该算法应用于122例连续入院的CAP患者的临床数据，这些患者的痰液样本进行了革兰氏染色，尿液进行了肺炎链球菌抗原检测。测量了初始抗菌治疗、人员和材料的成本。与最昂贵的经验性治疗方案相比，快速诊断检测可使每位患者（PP）通过革兰氏染色节省成本3.51欧元，通过尿肺炎球菌抗原检测节省成本8.11欧元（2000年至2002年，1欧元等于1.13美元）。与最便宜的治疗方案相比，革兰氏染色会使每位患者成本增加2.25欧元，尿抗原检测会使每位患者成本增加24.26欧元。在我们的研究环境中，使用快速诊断检测不会降低成本。然而，成本节省取决于所选不同抗生素价格的差异以及可评估和阳性样本的比例。
