Whittington Melanie D, Curtis Donna J, Atherly Adam J, Bradley Cathy J, Lindrooth Richard C, Campbell Jonathan D
Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO.
Children's Hospital Colorado, Aurora, CO.
Am J Infect Control. 2017 Jul 1;45(7):704-708. doi: 10.1016/j.ajic.2016.12.014. Epub 2017 Jan 23.
To mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections, intensive care units (ICUs) conduct surveillance through screening patients upon admission followed by adhering to isolation precautions. Two surveillance approaches commonly implemented are universal preemptive isolation and targeted isolation of only MRSA-positive patients.
Decision analysis was used to calculate the total cost of universal preemptive isolation and targeted isolation. The screening test used as part of the surveillance practice was varied to identify which screening test minimized inappropriate and total costs. A probabilistic sensitivity analysis was conducted to evaluate the range of total costs resulting from variation in inputs.
The total cost of the universal preemptive isolation surveillance practice was minimized when a polymerase chain reaction screening test was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time and thus higher isolation costs. The total cost of the targeted isolation surveillance practice was minimized when chromogenic agar 24-hour testing was used ($8.54 per patient). Costs were $22.41 more per patient when polymerase chain reaction was used.
For ICUs that preemptively isolate all patients, the use of a polymerase chain reaction screening test is recommended because it can minimize total costs by reducing inappropriate isolation costs. For ICUs that only isolate MRSA-positive patients, the use of chromogenic agar 24-hour testing is recommended to minimize total costs.
为减轻耐甲氧西林金黄色葡萄球菌（MRSA）感染，重症监护病房（ICU）通过在患者入院时进行筛查并随后遵守隔离预防措施来开展监测。通常实施的两种监测方法是普遍先发隔离和仅对MRSA阳性患者进行目标性隔离。
采用决策分析来计算普遍先发隔离和目标性隔离的总成本。作为监测实践一部分使用的筛查试验有所不同，以确定哪种筛查试验能将不适当成本和总成本降至最低。进行概率敏感性分析以评估因输入变量而导致的总成本范围。
当使用聚合酶链反应筛查试验时，普遍先发隔离监测实践的总成本降至最低（每位患者82.51美元）。由于周转时间较长且隔离成本较高，使用传统培养法时每位患者的成本多出207.60美元。当使用产色琼脂24小时检测时，目标性隔离监测实践的总成本降至最低（每位患者8.54美元）。使用聚合酶链反应时每位患者的成本多出22.41美元。
对于先发隔离所有患者的ICU，建议使用聚合酶链反应筛查试验，因为它可以通过降低不适当的隔离成本将总成本降至最低。对于仅隔离MRSA阳性患者的ICU，建议使用产色琼脂24小时检测以将总成本降至最低。
