Ulu-Kilic Aysegul, Özhan Esra, Altun Dilek, Perçin Duygu, Güneş Tamer, Alp Emine
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Am J Infect Control. 2016 Apr 1;44(4):e45-9. doi: 10.1016/j.ajic.2015.11.008. Epub 2016 Jan 5.
The screening of critically ill patients at high risk of vancomycin resistant enterococci (VRE) colonization, to detect and isolate colonized patients, is recommended to prevent and control the transmission of VRE. Screening asymptomatic carriers brings financial burden for institutions. In this study, we performed risk analysis for VRE colonization and determined the financial burden of screening in a middle-income country, Turkey.
We retrospectively analyzed the VRE surveillance data from a pediatric hospital between 2010 and 2014. A case-control study was conducted to identify the risk factors of colonization. Total cost of VRE screening and additional costs for a VRE colonized patient (including active surveillance cultures and contact isolation) were calculated.
During the 4-year period, 6,372 patients were screened for perirectal VRE colonization. The rate of culture-positive specimens among all patients screened was 239 (3.75%). The rate of VRE infection was 0.04% (n = 3) among all patients screened. Length of hospital stay, malignancy, and being transferred from another institution were independently associated risk factors for colonization. Annual estimated costs for the laboratory were projected as $19,074 (76,295/4) for all patients screened. Cost of contact isolation for each patient colonized in a ward and an intensive care unit was $270 and $718, respectively.
In developing countries, institutions should identify their own high-risk patients; screening priorities should be based on prevalence of infection and hospital financial resources.
建议对有耐万古霉素肠球菌（VRE）定植高风险的危重症患者进行筛查，以检测并隔离定植患者，从而预防和控制VRE的传播。对无症状携带者进行筛查会给医疗机构带来经济负担。在本研究中，我们对土耳其这个中等收入国家的VRE定植进行了风险分析，并确定了筛查的经济负担。
我们回顾性分析了一家儿科医院2010年至2014年的VRE监测数据。开展了一项病例对照研究以确定定植的风险因素。计算了VRE筛查的总成本以及VRE定植患者的额外费用（包括主动监测培养和接触隔离）。
在这4年期间，对6372例患者进行了直肠VRE定植筛查。所有接受筛查患者中培养阳性标本的比例为239例（3.75%）。所有接受筛查患者中VRE感染率为0.04%（n = 3）。住院时间、恶性肿瘤以及从其他机构转入是定植的独立相关风险因素。预计对所有接受筛查患者的实验室年度估计费用为19,074美元（76,295÷4）。病房和重症监护病房中每例定植患者的接触隔离费用分别为270美元和718美元。
在发展中国家，医疗机构应识别自身的高风险患者；筛查优先级应基于感染患病率和医院财务资源。
