title: Long-term clinical and economic benefits associated with the management of a nosocomial outbreak resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.
abstract: OBJECTIVE
  In 2005, there was an epidemic of infections resulting from extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the intensive care department. The aim of this study was to evaluate the potential long-term clinical and economic benefits resulting from the management of this epidemic and the resulting changes in practices.
  
  
  METHODS
  Two periods were defined: the period leading up to and including the epidemic (2003-2005; period I) and the postepidemic period (2006-2008; period II). We estimated the number of nosocomial infections prevented between these two periods in three ways: comparison of attack rates, incidence rates, and calculation of standardized infection ratios. A cost-benefit analysis was then carried out by multiplying the number of nosocomial infections prevented by their cost as estimated from a literature review.
  
  
  RESULTS
  The characteristics of the populations hospitalized during these two periods were comparable in terms of age, sex, Simplified Acute Physiologic Scale II score, origin, and type of diagnosis. The death rate was similar in the two periods (21.8% vs. 23.3%; p = .63). The number of nosocomial infections prevented was 54.1 (95% confidence interval 25.8-83.1; 30.4, 95% confidence interval 5.3-54.9; 32.8, 95% confidence interval 6.0-63.7; and 30.1, 95% confidence interval 17.7-42.5) according to the methodology. The savings cost potentially associated with the infection control intervention ranged from €149,928 (USD $183,781) to €269,472 (USD $330,318).
  
  
  CONCLUSIONS
  The management of this epidemic and the change in medical practices that it triggered were associated with a significant decrease in the number of infections acquired in the intensive care unit. There were substantial cost savings, highlighting the value of investment in the prevention of nosocomial infections.
authors.affiliation: Réseau Régional d'Hygiène, CHU Caen, France. emmanuel.piednoir@ch-avranches-granville.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Piednoir
authors.forename: Pascal
authors.initials: P
authors.lastname: Thibon
authors.forename: Guy-Claude
authors.initials: GC
authors.lastname: Borderan
authors.forename: Frédéric
authors.initials: F
authors.lastname: Godde
authors.forename: France
authors.initials: F
authors.lastname: Borgey
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Coutour
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007710:Klebsiella Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents