Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA.
Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA.
J Clin Microbiol. 2019 Jan 2;57(1). doi: 10.1128/JCM.01015-18. Print 2019 Jan.
Blood culture contamination results in increased hospital costs and exposure to antimicrobials. We evaluated the potential clinical and economic benefits of an initial specimen diversion device (ISDD) when routinely utilized for blood culture collection in the emergency department (ED) of a quaternary care medical center. A decision analysis model was created to identify the cost benefit of the use of the ISDD device in the ED. Probabilistic costs were determined from the published literature and the direct observation of pharmacy/microbiology staff. The primary outcome was the expected per-patient cost savings (microbiology, pharmacy, and indirect hospital costs) with the routine use of an ISDD from a hospital perspective. The indirect costs included those related to an increased hospital length of stay, additional procedures, adverse drug reactions, and hospital-acquired infections. Models were created to represent hospitals that routinely or do not routinely use rapid diagnostic tests (RDT) on positive blood cultures. The routine implementation of ISDD for blood culture collection in the ED was cost beneficial compared to conventional blood culture collection methods. When implemented in a hospital utilizing RDT with a baseline contamination rate of 6%, ISDD use was associated with a cost savings of $272 (3%) per blood culture in terms of overall hospital costs and $28 (5.4%) in direct-only costs. The main drivers of cost were baseline contamination rates and the duration of antibiotics given to patients with negative blood cultures. These findings support the routine use of ISDD during blood culture collection in the ED as a cost-beneficial strategy to reduce the clinical and economic impact of blood culture contamination in terms of microbiology, pharmacy, and wider indirect hospital impacts.
血培养污染会导致医院成本增加和接触抗菌药物。我们评估了在四级医疗中心急诊科常规使用初始标本分流装置（ISDD）时的潜在临床和经济效益。创建了决策分析模型来确定在急诊科使用 ISDD 装置的成本效益。概率成本来自已发表的文献和对药剂科/微生物学工作人员的直接观察。主要结果是从医院角度衡量常规使用 ISDD 装置每例患者的节省成本（微生物学、药剂学和间接医院成本）。间接成本包括与住院时间延长、额外的程序、药物不良反应和医院获得性感染相关的成本。创建了模型来代表常规或不常规使用快速诊断测试（RDT）的医院阳性血培养。与传统血培养采集方法相比，急诊科常规使用 ISDD 进行血培养采集具有成本效益。在常规使用 RDT 且污染率为 6%的医院中，ISDD 的使用与每例血培养的总医院成本节省 272 美元（3%）和直接成本节省 28 美元（5.4%）相关。成本的主要驱动因素是基线污染率和阴性血培养患者给予抗生素的持续时间。这些发现支持在急诊科血培养采集过程中常规使用 ISDD，这是一种降低血培养污染对微生物学、药剂学和更广泛的间接医院影响的临床和经济影响的具有成本效益的策略。
