title: Costs associated with implementation of a strict policy for controlling spread of highly resistant microorganisms in France.
abstract: OBJECTIVE
  To assess costs associated with implementation of a strict 'search and isolate' strategy for controlling highly drug-resistant organisms (HDRO).
  
  
  METHODS
  Review of data from 2-year prospective surveillance (01/2012 to 12/2013) of HDRO.
  
  
  METHODS
  Three university hospitals located in northern Paris.
  
  
  METHODS
  Episodes were defined as single cases or outbreaks of glycopeptide-resistant enterococci (GRE) or carbapenemase-producing Enterobacteriacae (CPE) colonisation. Costs were related to staff reinforcement, costs of screening cultures, contact precautions and interruption of new admissions. Univariate analysis, along with simple and multiple linear regression analyses, was conducted to determine variables associated with cost of HDRO management.
  
  
  RESULTS
  Overall, 41 consecutive episodes were included, 28 single cases and 13 outbreaks. The cost (mean ± SD) associated with management of a single case identified within and/or 48 h after admission was €4443 ± 11,552 and €11,445 ± 15,743, respectively (p<0.01). In an outbreak, the total cost varied from €14,864 ± 17,734 for an episode with one secondary case (€7432 ± 8867 per case) to €136,525 ± 151,231 (€12,845 ± 5129 per case) when more than one secondary case occurred. In episodes of single cases, contact precautions and microbiological analyses represented 51% and 30% of overall cost, respectively. In outbreaks, cost related to interruption of new admissions represented 77-94% of total costs, and had the greatest financial impact (R(2)=0.98, p<0.01).
  
  
  CONCLUSIONS
  In HDRO episodes occurring at three university hospitals, interruption of new admissions constituted the most costly measure in an outbreak situation.
authors.affiliation: INSERM, IAME, UMR 1137, Paris, France Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Birgand
authors.affiliation: Emergency Department, AP-HP, Hôpital Louis Mourier, Colombes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leroy
authors.affiliation: Infection Control Unit, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Simone
authors.initials: S
authors.lastname: Nerome
authors.affiliation: Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Liem Binh
authors.initials: LB
authors.lastname: Luong Nguyen
authors.affiliation: Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lolom
authors.affiliation: Bacteriology Laboratory, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefevre
authors.affiliation: Infection Control Unit, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Ciotti
authors.affiliation: Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lecorre
authors.affiliation: Infection Control Unit, AP-HP, Hôpital Louis Mourier, Colombes, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Marcade
authors.affiliation: Infection Control Unit, AP-HP, Hôpital Louis Mourier, Colombes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Fihman
authors.affiliation: Bacteriology Laboratory, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Nicolas-Chanoine
authors.affiliation: INSERM, IAME, UMR 1137, Paris, France Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Pelat
authors.affiliation: AP-HP, Hôpital Bichat-Claude Bernard, Medical Information Systems Program (PMSI), Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Perozziello
authors.affiliation: Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fantin
authors.affiliation: INSERM, IAME, UMR 1137, Paris, France Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France Infectious Diseases Department, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: INSERM, IAME, UMR 1137, Paris, France Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France Intensive Care Unit, AP-HP, Hôpital Louis Mourier, Colombes, France.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.affiliation: INSERM, IAME, UMR 1137, Paris, France Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D003428:Cross Infection / Q000191:economics* / Q000517:prevention & control*; D004351:Drug Resistance; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests / Q000191:economics; D010297:Paris; D011446:Prospective Studies
keywords: EPIDEMIOLOGY
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