In this section
@article{Knight:2018:10.1186/s12916-018-1117-4,
author = {Knight, GM and Dyakova, E and Mookerjee, S and Davies, F and Brannigan, E and Otter, J and Holmes, A},
doi = {10.1186/s12916-018-1117-4},
journal = {BMC Medicine},
title = {Fast and expensive (PCR) or cheap and slow (culture)? A mathematical modelling study to explore screening for carbapenem resistance in UK hospitals},
url = {http://dx.doi.org/10.1186/s12916-018-1117-4},
volume = {16},
year = {2018}
}
TY - JOUR
AB - BackgroundEnterobacteriaceae are a common cause of hospital infections. Carbapenems are a clinically effective treatment of such infections. However, resistance is on the rise. In particular, carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are increasingly common. In order to limit spread in clinical settings, screening and isolation is being recommended, but many different screening methods are available. We aimed to compare the impact and costs of three algorithms for detecting CP-CRE carriage.MethodsWe developed an individual-based simulation model to compare three screening algorithms using data from a UK National Health Service (NHS) trust. The first algorithm, “Direct PCR”, was highly sensitive/specific and quick (half a day), but expensive. The second, “Culture + PCR”, was relatively sensitive/specific but slower, requiring 2.5 days. A third algorithm, “PHE”, repeated the “Culture + PCR” three times with an additional PCR. Scenario analysis was used to compare several levels of CP-CRE prevalence and coverage of screening, different specialities as well as isolation strategies. Our outcomes were (1) days that a patient with CP-CRE was not detected and hence not isolated (“days at risk”), (2) isolation bed days, (3) total costs and (4) mean cost per CP-CRE risk day averted per year. We also explored limited isolation bed day capacity.ResultsWe found that although a Direct PCR algorithm would reduce the number of CP-CRE days at risk, the mean cost per CP-CRE risk day averted per year was substantially higher than for a Culture + PCR algorithm. For example, in our model of an intensive care unit, during a year with a 1.6% CP-CRE prevalence and 63% screening coverage, there were 508 (standard deviation 15), 642 (14) and 655 (14) days at risk under screening algorithms Direct PCR, Culture + PCR and PHE respectively, with mean costs per risk day averted of £192, £61 and
AU - Knight,GM
AU - Dyakova,E
AU - Mookerjee,S
AU - Davies,F
AU - Brannigan,E
AU - Otter,J
AU - Holmes,A
DO - 10.1186/s12916-018-1117-4
PY - 2018///
SN - 1741-7015
TI - Fast and expensive (PCR) or cheap and slow (culture)? A mathematical modelling study to explore screening for carbapenem resistance in UK hospitals
T2 - BMC Medicine
UR - http://dx.doi.org/10.1186/s12916-018-1117-4
UR - http://hdl.handle.net/10044/1/62018
VL - 16
ER -
