This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (164)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Critical Care/ Intensive Care Medicine  • Adult Critical Care  • Alert me on articles by topic

A Cost-Benefit Analysis in an Intensive Care Unit

Carine Chaix, MD; Isabelle Durand-Zaleski, MD, PhD; Corinne Alberti, MD; Christian Brun-Buisson, MD

JAMA. 1999;282:1745-1751.

Context  Despite the success of some countries in controlling endemic methicillin-resistant Staphylococcus aureus (MRSA), such programs have not been implemented for some hospitals with endemic infection because of concerns that these programs would be costly and of limited benefit.

Objective  To compare the costs and benefits of an MRSA control program in an endemic setting.

Design and Setting  Case-control study conducted at a medical intensive care unit (ICU) of a French university hospital with a 4% prevalence of MRSA carriage at ICU admission.

Patients  Twenty-seven randomly selected patients who had ICU-acquired MRSA infection between January 1993 and June 1997, matched to 27 controls hospitalized during the same period without MRSA infection.

Main Outcome Measures  Intensive care unit costs attributable to MRSA infection, computed from excess therapeutic intensity in cases using estimates from a cost model derived in the same ICU, were compared with costs of the control program, derived from time-motion study of nurses and physicians. The threshold for MRSA carriage that would make the control strategy dominant was determined; sensitivity analyses varied rates of MRSA transmission and ratio of infection to transmission, length of ICU stay, and costs of isolation precautions.

Results  The mean cost attributable to MRSA infection was US $9275 (median, $5885; interquartile range, $1400-$16,720). Total costs of the control program ranged from $340 to $1480 per patient. A 14% reduction in MRSA infection rate resulted in the control program being beneficial. In sensitivity analyses, the control strategy was dominant for a prevalence of MRSA carriage on ICU admission ranging from 1% to 7%, depending on costs of control measures and MRSA transmission, for infection rates greater than 50% following transmission.

Conclusions  In this example of a hospital with endemic MRSA infection, selective screening and isolation of carriers on ICU admission are beneficial compared with no isolation.

Author Affiliations: Department of Public Health (Drs Chaix, Durand-Zaleski, and Alberti), the Infection Control Unit and Medical Intensive Care Unit, Hôpital Henri Mondor (Dr Brun-Buisson), Créteil, France.

RELATED ARTICLE

November 10, 1999
JAMA. 1999;282(18):1787-1788.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Structure and Evolution of a Novel Dimeric Enzyme from a Clinically Important Bacterial Pathogen
Burgess et al.
J. Biol. Chem. 2008;283:27598-27603.
ABSTRACT | FULL TEXT  

Rapid Screening for Carriage of Methicillin-Resistant Staphylococcus aureus by PCR and Associated Costs
Buhlmann et al.
J. Clin. Microbiol. 2008;46:2151-2154.
ABSTRACT | FULL TEXT  

Evaluation of Three Molecular Assays for Rapid Identification of Methicillin-Resistant Staphylococcus aureus
Francois et al.
J. Clin. Microbiol. 2007;45:2011-2013.
ABSTRACT | FULL TEXT  

Concurrent Analysis of Nose and Groin Swab Specimens by the IDI-MRSA PCR Assay Is Comparable to Analysis by Individual-Specimen PCR and Routine Culture Assays for Detection of Colonization by Methicillin-Resistant Staphylococcus aureus.
Bishop et al.
J. Clin. Microbiol. 2006;44:2904-2908.
ABSTRACT | FULL TEXT  

MRSA: total war or tolerance?
Vogelaers
Nephrol Dial Transplant 2006;21:837-838.
FULL TEXT  

Identifying groups at high risk for carriage of antibiotic-resistant bacteria.
Furuno et al.
Arch Intern Med 2006;166:580-585.
ABSTRACT | FULL TEXT  

Is antibiotic resistance a problem? A practical guide for hospital clinicians
Barlow and Nathwani
Postgrad. Med. J. 2005;81:680-692.
ABSTRACT | FULL TEXT  

Detection of Methicillin-Resistant Staphylococcus aureus Directly from Nasal Swab Specimens by a Real-Time PCR Assay
Warren et al.
J. Clin. Microbiol. 2004;42:5578-5581.
ABSTRACT | FULL TEXT  

Comprehensive Strategy to Prevent Nosocomial Spread of Methicillin-Resistant Staphylococcus aureus in a Highly Endemic Setting
Tomic et al.
Arch Intern Med 2004;164:2038-2043.
ABSTRACT | FULL TEXT  

Clinicians' Perceptions of the Problem of Antimicrobial Resistance in Health Care Facilities
Giblin et al.
Arch Intern Med 2004;164:1662-1668.
ABSTRACT | FULL TEXT  

Infection Control in Cystic Fibrosis
Saiman and Siegel
Clin. Microbiol. Rev. 2004;17:57-71.
ABSTRACT | FULL TEXT  

Methicillin resistant Staphylococcus aureus in the critically ill
Hardy et al.
Br J Anaesth 2004;92:121-130.
ABSTRACT | FULL TEXT  

Rapid Screening and Identification of Methicillin-Resistant Staphylococcus aureus from Clinical Samples by Selective-Broth and Real-Time PCR Assay
Fang and Hedin
J. Clin. Microbiol. 2003;41:2894-2899.
ABSTRACT | FULL TEXT  

Prevalence and Risk Factors for Carriage of Methicillin-Resistant Staphylococcus aureus at Admission to the Intensive Care Unit: Results of a Multicenter Study
Lucet et al.
Arch Intern Med 2003;163:181-188.
ABSTRACT | FULL TEXT  

Rapid Detection of Methicillin-Resistant Staphylococcus aureus Directly from Sterile or Nonsterile Clinical Samples by a New Molecular Assay
Francois et al.
J. Clin. Microbiol. 2003;41:254-260.
ABSTRACT | FULL TEXT  

Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit
Haddadin et al.
Postgrad. Med. J. 2002;78:385-392.
ABSTRACT | FULL TEXT  

Infection Control in the ICU
Eggimann and Pittet
Chest 2001;120:2059-2093.
ABSTRACT | FULL TEXT  

Methicillin-Resistant Staphylococcus aureus Otorrhea After Tympanostomy Tube Placement: An Emerging Concern
Hartnick et al.
Arch Otolaryngol Head Neck Surg 2000;126:1440-1443.
ABSTRACT | FULL TEXT