Réseau Régional d'Hygiène, CHU Caen, France.
Crit Care Med. 2011 Dec;39(12):2672-7. doi: 10.1097/CCM.0b013e31822827e0.
In 2005, there was an epidemic of infections resulting from extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the intensive care department. The aim of this study was to evaluate the potential long-term clinical and economic benefits resulting from the management of this epidemic and the resulting changes in practices.
Two periods were defined: the period leading up to and including the epidemic (2003-2005; period I) and the postepidemic period (2006-2008; period II). We estimated the number of nosocomial infections prevented between these two periods in three ways: comparison of attack rates, incidence rates, and calculation of standardized infection ratios. A cost-benefit analysis was then carried out by multiplying the number of nosocomial infections prevented by their cost as estimated from a literature review.
The characteristics of the populations hospitalized during these two periods were comparable in terms of age, sex, Simplified Acute Physiologic Scale II score, origin, and type of diagnosis. The death rate was similar in the two periods (21.8% vs. 23.3%; p = .63). The number of nosocomial infections prevented was 54.1 (95% confidence interval 25.8-83.1; 30.4, 95% confidence interval 5.3-54.9; 32.8, 95% confidence interval 6.0-63.7; and 30.1, 95% confidence interval 17.7-42.5) according to the methodology. The savings cost potentially associated with the infection control intervention ranged from €149,928 (USD $183,781) to €269,472 (USD $330,318).
The management of this epidemic and the change in medical practices that it triggered were associated with a significant decrease in the number of infections acquired in the intensive care unit. There were substantial cost savings, highlighting the value of investment in the prevention of nosocomial infections.
2005 年，重症监护病房爆发了产超广谱β-内酰胺酶肺炎克雷伯菌感染疫情。本研究旨在评估管理该疫情及其引发的实践变化带来的潜在长期临床和经济效益。
定义了两个时期：疫情前及疫情期间（2003-2005 年；时期 I）和疫情后（2006-2008 年；时期 II）。我们通过比较发病率、发病率和计算标准化感染比三种方法，估计这两个时期之间预防的医院感染数量。然后通过乘以从文献回顾中估计的医院感染成本，进行成本效益分析。
两个时期住院患者的人口统计学特征在年龄、性别、简化急性生理评分 II 评分、来源和诊断类型方面相似。两个时期的死亡率相似（21.8%与 23.3%；p=.63）。根据方法学，预防的医院感染数量为 54.1（95%置信区间 25.8-83.1；30.4，95%置信区间 5.3-54.9；32.8，95%置信区间 6.0-63.7；和 30.1，95%置信区间 17.7-42.5）。感染控制干预措施可能带来的节省成本范围为 149928 欧元（183781 美元）至 269472 欧元（330318 美元）。
该疫情的管理和由此引发的医疗实践变化与重症监护病房获得性感染数量的显著减少有关。有大量的成本节约，突显了预防医院感染投资的价值。
