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Active surveillance for Enterobacteriaceae may be cost prohibitive
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Active surveillance for extended-spectrum beta-lactamase-producing Enterobacteriaceae, or ESBL-E, was able to identify most infants who were colonized or infected in a level 4 neonatal ICU, according to research published in Infection Control & Hospital Epidemiology. However, researchers suggest this strategy to reduce transmission may not be cost-effective.
“Of the myriad of strategies to prevent transmission of ESBL-E among hospitalized patients, active surveillance to identify and isolate patients colonized with ESBL-E has been a common practice, especially in high-risk populations such as NICU patients,” Xiaoyan Song, PhD, CIC, director of infection control and epidemiology at Children’s National Health System, and colleagues wrote. “Active surveillance continues to be the recommendation of the CDC as a core prevention strategy.”
Song and colleagues conducted a retrospective observational study that included data gathered between 1999 and March 2018 related to NICU patients with ESBL-E colonization or infection. During this study period and until March 2017, rectal swab specimens were collected during the admission process and once weekly after admission.
Of the 171 NICU patients with confirmed ESBL-E colonization or infection, most were identified using active surveillance (87.7%), with an overall incidence rate of 1.4 per 100 NICU admissions.
Hospital-acquired infections had an overall incidence rate of 0.41 per 1,000 patient days. By 2002, Song and colleagues observed this rate decreased to an average of six cases per year. A further decrease was identified when the NICU began using a new single-bed unit with private rooms in 2009. After active surveillance was discontinued, no increase in cases was observed among neonates. Few patients (9.3%) developed infection after colonization was identified.
The researchers wrote that to identify one ESBL-E colonized patient, $848 would be needed. The 50,950 specimens collected cost $127,187 to process.
“For 12 months after the discontinuation of active surveillance, ESBL infection rates have remained unchanged, indicating that the existing measures, such as private rooms, contact precautions and handwashing, may be far more important contributors to low rates than active surveillance alone,” Song and colleagues wrote. “These findings suggest that the change of stopping active surveillance will result in cost savings of approximately $70,000 over 10 years.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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