Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-05T15:20:45.896Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Microbiology Costs for Methods of Active Surveillance for Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae

Published online by Cambridge University Press:  10 May 2016

Amy J. Mathers ,
Melinda Poulter ,
Dawn Dirks ,
Joanne Carroll ,
Costi D. Sifri  and
Kevin C. Hazen
Amy J. Mathers*
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Melinda Poulter
Affiliation:
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Dawn Dirks
Affiliation:
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Joanne Carroll
Affiliation:
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Costi D. Sifri
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Kevin C. Hazen
Affiliation:
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
*
Division of Infectious Diseases and International Health, University of Virginia Health System, PO Box 801361, Charlottesville, VA 22908 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To compare direct laboratory costs of different methods for perirectal screening for carbapenemase-producing Enterobacteriaceae (CPE) colonization.

Design.

Cost-benefit analysis.

Setting.

A university hospital and affiliated long-term acute care hospital (LTACH).

Participants.

Inpatients from the hospital or LTACH.

Methods.

Perirectal samples were collected from inpatients at risk for exposure to CPE. In 2009, we compared the accuracy of the Centers for Disease Control and Prevention (CDC)-recommended CPE screening method with similar methods incorporating a chromogenic agar (CA). We then performed a cost projection analysis using 2012 screening results for the CA method, the CDC method, and a molecular assay with wholesale pricing based on the 2009 analysis. Comparisons of turnaround and personnel time were also performed.

Results.

A total of 185 (2.7%) of 6,860 samples were confirmed as CPE positive during 2012. We previously found that the CDC protocol had a lower sensitivity than the CA method and predicted that the CDC protocol would have missed 92 of the CPE-positive screening results, whereas the modified protocol using CA would have missed 26, assuming similar prevalence and performance. Turnaround time was 3 days using the CDC and CA-modified protocols compared with 1 day for molecular testing. The estimated annual total program cost and total technologist's hours would be the following: CA-modified protocol, $37,441 and 376 hours; CDC protocol, $22,818 and 482 hours; and molecular testing, $224,596 and 343 hours.

Conclusions.

The CDC screening protocol appeared to be the least expensive perirectal screening method. However, expense must be weighed against a lower sensitivity and extra labor needed for additional work-up of non-CPE isolates. The molecular test has the shortest turnaround time but the greatest expense.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 350 - 355
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a.

Clinical Microbiology Laboratory, Department of Pathology, Duke University Health System, Durham, North Carolina.

References

1. Correa, L, Martino, MD, Siqueira, I, et al. A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection. BMC Infect Dis 2013;13:80.Google Scholar
2. Zarkotou, O, Pournaras, S, Tselioti, P, et al. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect 2011;17(12):1798–1803.Google Scholar
3. Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29(12):1099–1106.CrossRefGoogle ScholarPubMed
4. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58(10):256–260.Google Scholar
5. Calfee, D, Jenkins, SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29(10):966–968.Google Scholar
6. Ben-David, D, Maor, Y, Keller, N, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31(6):620–626.Google Scholar
7. Kochar, S, Sheard, T, Sharma, R, et al. Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2009;30(5): 447–452.Google Scholar
8. Ciobotaro, P, Oved, M, Nadir, E, Bardenstein, R, Zimhony, O. An effective intervention to limit the spread of an epidemic carbapenem-resistant Klebsiella pneumoniae strain in an acute care setting: from theory to practice. Am J Infect Control 2011;39(8):671–677.Google Scholar
9. Mathers, AJ, Cox, HL, Kitchel, B, et al. Molecular dissection of an outbreak of carbapenem-resistant Enterobacteriaceae reveals intergenus KPC carbapenemase transmission through a promiscuous plasmid. MBio 2011;2(6):e00204–11.Google Scholar
10. Mathers, AJ, Carroll, J, Sifri, CD, Hazen, KC. Modified Hodge test versus indirect carbapenemase test: prospective evaluation of a phenotypic assay for detection of Klebsiella pneumoniae carbapenemase (KPC) in enterobacteriaceae. J Clin Microbiol 2013;51(4):1291–1293.CrossRefGoogle ScholarPubMed
11. US Department of Labor, Bureau of Labor Statistics. Occupational employment and wages. In: Occupational Outlook Handbook. Washington, DC: Office of Publications and Special Studies, 2012. http://www.bls.gov/OPUB.Google Scholar
12. Mathers, AJ, Hazen, KC, Carroll, J, et al. First clinical cases of oxa-48-producing carbapenem-resistant Klebsiella pneumoniae in the United States: the “menace” arrives in the new world. J Clin Microbiol 2013;51(2):680–683.Google Scholar
13. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848–855.Google Scholar
14. Centers for Disease Control and Prevention. CfDCaP. Vital signs: carbapenem-resistant enterobacteriaceae. MMWR Morb Mortal Wkly Rep 2013;62(9):165–170.Google Scholar
15. Doumith, M, Ellington, MJ, Livermore, DM, Woodford, N. Molecular mechanisms disrupting porin expression in ertapenem-resistant Klebsiella and Enterobacter spp.: clinical isolates from the UK. J Antimicrob Chemother 2009;63(4):659–667.Google Scholar
16. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17(10):1791–1798.CrossRefGoogle ScholarPubMed