Wang Elizabeth Wenqian, Weekley Ashlee, McCarty Jennifer, Koo Hoonmo, Lembcke Bradley, Al Mohajer Mayar
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.
Avicenna J Med. 2021 Jan 5;11(1):27-32. doi: 10.4103/ajm.ajm_193_19. eCollection 2021 Jan-Mar.
Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of (formerly ) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost.
The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT.
In the pre-intervention period, 15.5% of the total 3513 NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin ( < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% ( = 0.008).
The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in testing, an increase in compliance with enteric isolation, and significant cost savings.
更新后的国际指南推荐使用两步算法（谷氨酸脱氢酶[GDH]或核酸扩增检测[NAAT]加毒素检测）而非单独使用NAAT来诊断艰难梭菌（以前称为难辨梭状芽孢杆菌）感染。我们项目的目标是评估一项新的综合措施对医院获得性艰难梭菌感染（CDIs）发生率、医院获得性CDI标准化感染比值（SIR）、抗生素治疗天数（DOT）和财务成本的影响。
新的综合措施于2018年4月实施。该综合措施在天主教健康倡议组织（CHI）德克萨斯分部的五家医院推行。该综合措施包括从NAAT切换到两步法（GDH和毒素检测）。我们将新检测方法列入医嘱面板，其中包括肠道隔离和艰难梭菌检测的必要指征。我们使用干预前后的季度数据来计算SIR和DOT。
在干预前期，3513次NAAT检测中，15.5%呈阳性。在干预后期，2845次GDH和毒素检测中，5.7%的检测结果显示GDH和毒素均呈阳性（P<0.0001）。调整了分母和检测方法变化后的SIR也从1.02降至0.43。与阳性艰难梭菌病例相关的估计成本从1,932,150美元降至1,113,800美元，估计每年节省成本794,150美元。肠道隔离的依从性从73.1%提高到92.5%（P=0.008）。
新的检测综合措施显著降低了医院获得性CDI和不必要的治疗，减少了艰难梭菌检测，提高了肠道隔离的依从性，并节省了大量成本。
