Public Health Computational and Operations Research, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Clin Microbiol Infect. 2011 Nov;17(11):1691-7. doi: 10.1111/j.1469-0691.2011.03491.x. Epub 2011 Apr 4.
Although Acinetobacter baumannii (A. baumannii) is an increasingly common nosocomial pathogen that can cause serious infections in the intensive care unit (ICU), most ICUs do not actively screen admissions for this pathogen. We developed an economic computer simulation model to determine the potential cost-consequences to the hospital of implementing routine A. baumannii screening of ICU admissions and isolating those patients who tested positive, comparing two screening methods, sponge and swab, with each other and no screening. Sensitivity analyses varied the colonization prevalence, percentage of colonized individuals who had active A. baumannii infections, A. baumannii reproductive rate (R), and contact isolation efficacy. Both screening methods were cost-effective for almost all scenarios tested, yielding cost-savings ranging from -$1 to -$1563. Sponge screening was not cost-saving when colonization prevalence was ≤1%, probability of infection ≤30%, R ≤ 0.25, and contact isolation efficacy ≤25%. Swab screening was not cost-saving under these same conditions when the probability of infection was ≤40%. Sponge screening tended to be more cost-saving than swab screening (additional savings ranged from $1 to $421). Routine A. baumannii screening of ICU patients may save costs for hospitals.
虽然鲍曼不动杆菌（A.baumannii）是一种日益常见的医院病原体，可在重症监护病房（ICU）引起严重感染，但大多数 ICU 并未积极筛查该病原体。我们开发了一种经济计算机模拟模型，以确定对医院实施 ICU 入院常规 A.baumannii 筛查并对检测呈阳性的患者进行隔离的潜在成本后果，将两种筛查方法（海绵和拭子）相互比较，并与不筛查进行比较。敏感性分析改变了定植率、有活性的 A.baumannii 感染个体的百分比、A.baumannii 的繁殖率（R）和接触隔离效果。对于测试的几乎所有情况，这两种筛查方法都具有成本效益，节省的成本范围为-1 美元至-1563 美元。当定植率≤1%、感染概率≤30%、R≤0.25 和接触隔离效果≤25%时，海绵筛查不能节省成本。在感染概率≤40%的情况下，拭子筛查也不能节省成本。在相同条件下，海绵筛查比拭子筛查更具成本效益（节省额从 1 美元到 421 美元不等）。对 ICU 患者进行常规 A.baumannii 筛查可能会为医院节省成本。
