Nulens E, Broex E, Ament A, Deurenberg R H, Smeets E, Scheres J, van Tiel F H, Gordts B, Stobberingh E E
Medical Microbiology, Algemeen Ziekenhuis Sint-Jan, Brugge, Belgium.
J Hosp Infect. 2008 Apr;68(4):301-7. doi: 10.1016/j.jhin.2008.01.018. Epub 2008 Mar 19.
Costs related to a search and destroy policy and treatment for Staphylococcus aureus bacteraemia in the University Hospital Maastricht were calculated for the period 2000 and 2004. The financial cost-benefit break-even point of the search and destroy policy was determined by modelling. On average 22,412 patients were admitted per year for an average of 8.7 days. Each year 246 patients were screened for meticillin-resistant Staphylococcus aureus (MRSA) and 74 patients were decolonised and nursed in preventive isolation. The prevalence of MRSA in the University Hospital Maastricht was 0.7%, as calculated from positive blood cultures, and mean length of stay for all patients with S. aureus bloodstream infections was 39.9 days. The annual cost of pro-active searching for MRSA in the University Hospital Maastricht was euro 1,383,200, and euro 2,736,762 for MRSA prevention and treatment of S. aureus bloodstream infections. Simulation of a variety MRSA/meticillin-susceptible S. aureus (MSSA) ratios showed that even if the MRSA prevalence reaches 8%, prevention costs are still lower than the cost of treating S. aureus infections. In conclusion, the total cost of a search and destroy policy is lower than the cost of treating S. aureus bloodstream infections in the University Hospital Maastricht. At an MRSA prevalence of <or=8% the search and destroy policy remains cost-effective. From an economic point of view, the search and destroy policy is the best alternative at maintaining an endemic MRSA level at <1%.
计算了2000年至2004年期间马斯特里赫特大学医院与金黄色葡萄球菌菌血症的筛查清除策略及治疗相关的成本。通过建模确定了筛查清除策略的财务成本效益平衡点。平均每年有22412名患者入院，平均住院8.7天。每年对246名患者进行耐甲氧西林金黄色葡萄球菌（MRSA）筛查，74名患者进行去定植并接受预防性隔离护理。根据血培养阳性结果计算，马斯特里赫特大学医院MRSA的患病率为0.7%，所有金黄色葡萄球菌血流感染患者的平均住院时间为39.9天。马斯特里赫特大学医院主动筛查MRSA的年度成本为1383200欧元，预防和治疗金黄色葡萄球菌血流感染的MRSA年度成本为2736762欧元。对多种MRSA/甲氧西林敏感金黄色葡萄球菌（MSSA）比例的模拟显示，即使MRSA患病率达到8%，预防成本仍低于治疗金黄色葡萄球菌感染的成本。总之，在马斯特里赫特大学医院，筛查清除策略的总成本低于治疗金黄色葡萄球菌血流感染的成本。当MRSA患病率≤8%时，筛查清除策略仍具有成本效益。从经济角度来看，在将MRSA地方流行水平维持在<1%时，筛查清除策略是最佳选择。
