血管外科患者术前应筛查耐甲氧西林金黄色葡萄球菌吗？
Should vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus?
机构信息
Section of Decision Sciences and Clinical Systems Modeling, Department of Biomedical Informatics, School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
出版信息
Infect Control Hosp Epidemiol. 2009 Dec;30(12):1158-65. doi: 10.1086/648087.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infection in patients who are undergoing vascular surgical operations. Testing all vascular surgery patients preoperatively for MRSA and attempting to decolonize those who have positive results may be a strategy to prevent MRSA infection. The economic value of such a strategy has not yet been determined.
METHODS
We developed a decision-analytic computer simulation model to determine the economic value of using such a strategy before all vascular surgical procedures from the societal and third-party payer perspectives at different MRSA prevalence and decolonization success rates.
RESULTS
The model showed preoperative MRSA testing to be cost-effective (incremental cost-effectiveness ratio, <$50,000 per quality-adjusted life year) when the MRSA prevalence is > or = 0.01 and the decolonization success rate is > or = 0.25. In fact, this strategy was dominant (ie, less costly and more effective) at the following thresholds: MRSA prevalence > or = 0.01 and decolonization success rate > or = 0.5, and MRSA prevalence > or = 0.025 and decolonization success rate > or = 0.25.
CONCLUSION
Testing and decolonizing patients for MRSA before vascular surgery may be a cost-effective strategy over a wide range of MRSA prevalence and decolonization success rates.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）可导致正在接受血管外科手术的患者发生严重感染。对所有血管外科手术患者进行术前 MRSA 检测，并对检测结果阳性者进行去定植，可能是预防 MRSA 感染的一种策略。但这种策略的经济价值尚未确定。
方法
我们开发了一个决策分析计算机模拟模型，从社会和第三方支付者的角度，在不同的 MRSA 流行率和去定植成功率下，确定在所有血管外科手术前采用这种策略的经济价值。
结果
该模型显示，当 MRSA 流行率≥0.01 且去定植成功率≥0.25 时，术前 MRSA 检测具有成本效益（增量成本效益比<50000 美元/质量调整生命年）。实际上，在以下阈值下，这种策略具有优势（即成本更低、效果更好）：MRSA 流行率≥0.01 且去定植成功率≥0.5，或 MRSA 流行率≥0.025 且去定植成功率≥0.25。
结论
血管外科手术前对患者进行 MRSA 检测和去定植可能是一种具有成本效益的策略，适用于广泛的 MRSA 流行率和去定植成功率。
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