Implementation Impact of Methicillin-resistant Staphylococcus aureus (MRSA) Rapid Molecular Testing on Hospital-Related Quality and Cost of Care.

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-10-09 DOI:10.1016/j.jhin.2025.09.013

Amy Pinsent, Kerry Winter, Jordan Chase, Christophe Martinaud, David P Nicolau, Henri Folse

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Abstract

Background: The implementation of proactive screening has reduced methicillin-resistant Staphylococcus aureus (MRSA) infections in hospital settings. This study evaluated the health and cost implications of the utilization of a rapid PCR-based testing strategy compared to conventional strategies for MRSA control.

Methods: A cost-consequence analysis incorporating conventional interventional and infection-related expenditures was developed to estimate the health and economic impact of rapid PCR-based screening compared to no screening, universal decolonization, and culture-based screening from a U.S. hospital perspective. The analysis included patients hospitalized in general wards at risk of MRSA infection over a 30-day time horizon. The model inputs were informed by the published literature. Sensitivity and scenario analyses were conducted to examine the impact of key parameters and assumptions.

Results: In a 1,000-patient cohort, compared to culture-based screening with and without pre-emptive isolation, the rapid PCR-based screening saved $11,842,498 and $5,625,278, respectively, in total costs and reduced health outcomes while resulting in fewer infections, deaths, and onward transmissions compared to conventional culture screening without pre-emptive isolation. Compared to universal decolonization, the rapid PCR-based strategy saved $12,353,893 in total costs. Although the total costs increased for molecular screening due to higher bed day costs compared to no active screening, the rapid PCR-based strategy averted infections, subsequent deaths, and onward transmissions. Sensitivity and scenario analyses confirmed the robustness of these findings.

Conclusions: Compared to other interventional strategies to reduce MRSA-related sequelae in the hospital setting routine testing with rapid PCR-based screening shows potential for improved health outcomes and cost savings.

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耐甲氧西林金黄色葡萄球菌（MRSA）快速分子检测对医院相关护理质量和成本的实施影响

背景：主动筛查的实施减少了医院环境中的耐甲氧西林金黄色葡萄球菌（MRSA）感染。本研究评估了与传统MRSA控制策略相比，使用基于pcr的快速检测策略对健康和成本的影响。方法：从美国医院的角度出发，结合传统介入和感染相关支出进行成本-后果分析，以评估基于pcr的快速筛查与不筛查、普遍去殖民化和基于培养的筛查相比对健康和经济的影响。该分析包括30天内有MRSA感染风险的普通病房住院患者。模型输入由已发表的文献提供信息。进行了敏感性和情景分析，以检验关键参数和假设的影响。结果：在1000例患者队列中，与有和没有先发制人隔离的基于培养的筛查相比，基于pcr的快速筛查在总成本和降低健康结果方面分别节省了11,842,498美元和5,625,278美元，同时与没有先发制人隔离的传统培养筛查相比，导致的感染、死亡和进一步传播减少了。与普遍非殖民化相比，基于快速聚合酶链反应的战略节省了总费用12 353 893美元。尽管与不进行主动筛查相比，由于住院日费用较高，分子筛查的总成本增加了，但基于pcr的快速策略避免了感染、随后的死亡和进一步传播。敏感性和情景分析证实了这些发现的稳健性。结论：与其他减少医院mrsa相关后遗症的介入策略相比，常规检测与基于快速pcr的筛查显示出改善健康结果和节省成本的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.