Measures to eradicate multidrug-resistant organism outbreaks: how much do they cost?
This study aimed to assess the economic burden of infection control measures that succeeded in eradicating multidrug-resistant organisms (MDROs) in emerging epidemic contexts in hospital settings. The MEDLINE, EMBASE and Ovid databases were systematically interrogated for original English-language articles detailing costs associated with strict measures to eradicate MDROs published between 1 January 1974 and 2 November 2014. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 13 original articles were retrieved reporting data on several MDROs, including glycopeptide-resistant enterococci (n = 5), carbapenemase-producing Enterobacteriacae (n = 1), methicillin-resistant Staphylococcus aureus (n = 5), and carbapenem-resistant Acinetobacter baumannii (n = 2). Overall, the cost of strict measures to eradicate MDROs ranged from €285 to €57 532 per positive patient. The major component of these overall costs was related to interruption of new admissions, representing €2466 to €47 093 per positive patient (69% of the overall mean cost; range, 13-100%), followed by mean laboratory costs of €628 to €5849 (24%; range, 3.3-56.7%), staff reinforcement costs of €6204 to €148 381 (22%; range, 3.3-52%), and contact precautions costs of €166 to €10 438 per positive patient (18%; range, 0.7-43.3%). Published data on the economic burden of strict measures to eradicate MDROs are limited, heterogeneous, and weakened by several methodological flaws. Novel economic studies should be performed to assess the financial impact of current policies, and to identify the most cost-effective strategies to eradicate emerging MDROs in healthcare facilities.
Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; INSERM, IAME, UMR 1137, Paris Diderot University, Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Infection Control Unit, Paris, France. Electronic address: gbirgand@gmail.com.
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Birgand
Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
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Moore
Nantes Teaching Hospital, Infection Control Unit, Nantes, France.
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Bourigault
Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
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Vella
Nantes Teaching Hospital, Infection Control Unit, Nantes, France.
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Lepelletier
Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
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Holmes
INSERM, IAME, UMR 1137, Paris Diderot University, Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Infection Control Unit, Paris, France.
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Lucet
D006801:Humans; D001424:Bacterial Infections / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D017048:Health Care Costs; D017053:Infection Control / Q000191:economics
Carbapenemase-producing Enterobacteriaceae; carbapenem-resistant Acinetobacter baumannii; contact precautions; glycopeptide-resistant enterococci; infection control; methicillin-resistant Staphylococcus aureus; search and isolate