1Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany.
2Institute of Hygiene and Environmental Health, University Medicine of Greifswald, Walther-Rathenau-Straße 49a, 17489 Greifswald, Germany.
Antimicrob Resist Infect Control. 2018 Nov 29;7:147. doi: 10.1186/s13756-018-0442-x. eCollection 2018.
Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective.
A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented.
The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51.
The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.
医院感染是医院中最常见的并发症之一。其中很大一部分是由多药耐药菌（MDRO）引起的。耐甲氧西林金黄色葡萄球菌（MRSA）仍然是最突出和最常见的 MDRO。早期发现多重耐药菌携带者是减少 MDRO 引起的医院感染的有效措施。对于计划去医院的患者，建议对 MDRO 进行门诊筛查和住院前去定植。然而，从经济角度来看，这种入院前 MDRO 管理在计划住院前的准备中的有效性尚未得到充分的科学检验。
将使用决策树为门诊和住院部门的 MDRO 筛查和治疗制定方案，以 MRSA 阳性患者为例。随后，将介绍各自策略的预期成本。
决策树分析表明，门诊 MRSA 管理的预期成本为 8.24 欧元，住院 MRSA 管理的预期成本为 672.51 欧元。
将 MRSA 筛查提前到门诊部门，并对计划住院的患者进行随后的门诊去定植，是最具成本效益的策略，应成为标准的受益措施。不考虑机会成本，住院 MRSA 管理的预期成本为 54.94 欧元。
