Patel Twisha S, Kaakeh Rola, Nagel Jerod L, Newton Duane W, Stevenson James G
Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan, USA.
Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
J Clin Microbiol. 2016 Dec 28;55(1):60-67. doi: 10.1128/JCM.01452-16. Print 2017 Jan.
Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44). The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million.
评估快速诊断检测加管理干预措施的研究一直表明，血流感染患者的临床结局得到了改善。然而，实施新的快速诊断检测的成本可能很高，而且此类检测通常不会带来额外收入。关于增加基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）用于快速鉴定病原体以及投入药学管理工作人员时间对医院总成本的影响，相关数据极少。利用医院成本核算系统生成的患者数据进行了成本分析，其中包括MALDI-TOF设备、耗材和人员的额外成本，以及药剂师用于审查血培养和对抗菌治疗进行干预的专门时间。成本分析是从医院角度在实施MALDI-TOF加管理干预措施之前和之后的3个月时间段内进行的。共有480例血流感染患者纳入分析：干预前组247例，干预组233例。干预组的30天死亡率显著改善（12%对21%，P<0.01）；平均住院时间缩短，尽管差异无统计学意义（13.0±16.5天对14.2±16.7天，P = 0.44）。干预组每例血流感染的医院总成本较低（42,580美元对45,019美元）。每组中，每例血流感染的重症监护病房成本在总成本中占比最大，干预组也较低（10,833美元对13,727美元）。实施MALDI-TOF加管理审查和干预降低了血流感染患者的死亡率。尽管实施MALDI-TOF以及投入药学管理工作人员时间进行干预会产生额外成本，但每例血流感染的医院总成本仍降低了2,439美元，每年大约节省成本234万美元。
