Department of Internal Medicine I, Gastroenterology Unit, University Hospital of the Ruhr - University Bochum, Marienhospital Herne, Hölkeskampring 40, 44625 Herne, Germany.
Int J Hyg Environ Health. 2013 Mar;216(2):126-31. doi: 10.1016/j.ijheh.2012.04.005. Epub 2012 Jun 8.
There is evidence that pre-admission screening and decolonization (PreASD) of MRSA can reduce costs in elective surgical patients. It is not known whether this strategy could also be successfully applied to general medical patients of a tertiary referral hospital with multiple specialties. Our study retrospectively evaluates the eligibility of patients for MRSA-PreASD in a setting of active targeted MRSA surveillance. We carried out a survey among eligible patients to assess acceptance and feasibility of MRSA-PreASD. Of 10,496 admissions to our university hospital 8912 (84.9%) were screened for MRSA-risk factors. In 5382 admissions at risk swabs were taken and analyzed. Using the Appropriateness Evaluation Protocol (AEP) we retrospectively assessed how many of the 5382 admissions at risk could have been postponed for the duration of an MRSA-PreASD. 36 (17%) of 212 admissions with proven MRSA colonization and 2175 (42%) of 5170 patients without detectable MRSA could have been sent home for MRSA-PreASD to be electively admitted later. Of the 36 admissions (35 patients) with proven MRSA eligible for PreASD 23 patients (65%) responded to an interview. 22 of those (95.6%) would have agreed to PreASD. Additional costs for a screening protocol adapted to the needs of MRSA-PreASD of 52,061€ were estimated. Additional hospitalization costs of 6100-9300€ per MRSA case in Germany have been published. In our study population the successful pre-admission decolonization of 22 cases (63% of 35 patients eligible) may therefore have saved about 134,000-205,000€. Thus from an economic point of view our concept should be justified. In conclusion a relevant number of affected admissions to our tertiary referral hospital is eligible for an MRSA-PreASD. The majority of patients with proven MRSA-colonization eligible for a pre-admission decolonization treatment would prefer such an approach over being isolated at the hospital. The implementation of an MRSA-PreASD-protocol may reduce costs.
有证据表明，对耐甲氧西林金黄色葡萄球菌（MRSA）患者进行入院前筛查和去定植（PreASD）可以降低择期手术患者的成本。但尚不清楚这种策略是否也可以成功应用于一家三级转诊医院的普通内科患者，该医院有多个专业科室。我们的研究回顾性评估了在主动靶向 MRSA 监测环境下，患者接受 MRSA-PreASD 的资格。我们对符合条件的患者进行了一项调查，以评估其对 MRSA-PreASD 的接受度和可行性。在我们大学医院的 10496 例住院患者中，有 8912 例（84.9%）接受了 MRSA 危险因素筛查。在 5382 例高危住院患者中采集并分析了拭子样本。使用适宜性评估方案（AEP），我们回顾性评估了 5382 例高危住院患者中有多少例可以推迟一段时间进行 MRSA-PreASD。在有明确 MRSA 定植的 212 例住院患者中，有 36 例（17%）和在 5170 例未检出 MRSA 的患者中，有 2175 例（42%）可以回家进行 MRSA-PreASD，然后择期住院。在有明确 MRSA 定植且符合 PreASD 条件的 36 例住院患者（35 例患者）中，有 23 例（65%）接受了采访。其中 22 例（95.6%）表示愿意接受 PreASD。预计适应性筛选方案的额外费用为 52061 欧元。在德国，每例 MRSA 病例的额外住院费用为 6100-9300 欧元。在我们的研究人群中，成功的入院前去定植 22 例（35 例符合条件的患者中的 63%）可能节省了约 134000-205000 欧元。因此，从经济角度来看，我们的概念应该是合理的。结论是，我们的三级转诊医院有相当数量的相关住院患者适合进行 MRSA-PreASD。大多数有明确 MRSA 定植且符合入院前去定植治疗条件的患者，更倾向于这种方法，而不是在医院进行隔离。实施 MRSA-PreASD 方案可能会降低成本。
