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Economic and medical adverse effects of a national policy to control the spread of highly-resistant micro-organisms. G Birgand a , M Schwarzinger b , A Perozziello c , C Pelat b , L Armand-Lefevre, E Ruppé d , JC Buzzi c , A Andremont d , Y Yazdanpanah b , JC Lucet a

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  1. Economic and medicaladverse effects of a national policy to control the spread of highly-resistant micro-organisms. G Birgand a, M Schwarzinger b, A Perozziello c, C Pelat b, L Armand-Lefevre, E Ruppé d, JC Buzzi c, A Andremont d , Y Yazdanpanah b, JC Lucet a aInfection control unit, Bichat-Claude Bernard Hospital, Paris, France bATIP-Avenir, Inserm U738, Paris, France; c Medical Infomation Systems Program (PMSI), Bichat-Claude Bernard Hospital, Paris, France; dBacteriology laboratory, Bichat-Claude Bernard Hospital, Paris, France

  2. G. Birgand Disclosure statement Financial support: none Conflict of interest: Pfizer: Travel grant for the ICAAC 2011 ECCMID Berlin 2013

  3. G. Birgand IntroductionEpidemiological context GRE CPE E.Faecium VR EARSS 2011 Kp Carba-R EARSS 2011 ECCMID Berlin 2013

  4. G. Birgand Introduction French National Recommandations Patients detected colonised with GRE or CPE: • Single room + contact precautions for carriers and contact patients along the entire hospital stay • Cohorting of carriers and contact patients in 2 different dedicated areas with dedicated staff 24/7 • Interruption of transfers of carriers and contact patients +interruption of new admissions • Repeated rectal sampling of contact patients: D0, D7, D15 ECCMID Berlin 2013

  5. G. Birgand Introduction Potential consequences of guidelines • Medical impact: • Unintended deleterious adverse effects for patients ? • Disruption for the ward • Delays in patient’s care and transfer • Economical impact: • Lost income due to interruption of transfers and admissions (French daily incomes for 1 hospital day: € 300-400 in medical units to € 1700 - 2000 in ICU) • Cost of lab techniques and contact precautions • Cost of additional staff for cohorting ECCMID Berlin 2013

  6. G. Birgand Objectives • Patients colonised with GRE or CPE € Length of stay • Characteristics of hospital stays • The additional • hospital costs From 01/2009 to 06/2012 (3.5 years) in a 1000-bed University Hospital 6 ECCMID Berlin 2013

  7. G. Birgand MethodsStudy design Cases Patient colonised or infectedwithGRE or CPE Controls Patient neveridentified as colonizedwith GRE or CPE Matchingcriteria: gender, ward, period of hospitalisation (n-1), Age, diagnosis-related group (DRG) • Outcomes: • Length of hospital stay and overall hospital cost • Retrospective data collection: • Clinical, microbiological and hospital stay characteristics • Estimated costs of inpatient care based on reimbursement rates of the DRG (national yearly survey, 2011) • Statistical analysis: • Univariate and multivariate ANOVA (SAS and Stata v10)

  8. G. Birgand MethodsStudy population • 37 Pts identified colonised during the study period: • 4 death • 7 still hospitalised 107 surviving patients 26 cases colonised 81 Controlsneveridentified 1 1 18 6 14 GRE 12 CPE 10 vanA 4 vanB 9 OXA-48 2 KPC 1 NDM-1 ECCMID Berlin 2013

  9. G. Birgand ResultsDescription of cases

  10. G. Birgand ResultsUnivariate analysis (1) Characteristics Cases N= 26 (%) Controls N= 81 (%) P Age, median (IQR) 65 (57-77) 65 (56-77) 0.84 Female 11 (42) 33 (41) 0.89 Diagnosis-related group 1.00 Respiratory diseases 9 (35) 28 (35) Diabetes 3 (12) 8 (10) Vascular diseases 4 (15) 20 (24) Infectious diseases 3 (11) 9 (11) Others 7 (27) 16 (20) Charlson score, median (IQR) 6 (4-7) 4 (3-6) 0.1 Mc Cabe score 0.55 0 7 (27) 28 (36) 1 17 (65) 42 (53) 2 2 (8) 9 (11) Ward at the time of identification 0.73 ICU 5 (19) 15 (19) Medical unit 15 (58) 53 (65) Surgical unit 6 (23) 13 (16)

  11. G. Birgand ResultsUnivariate analysis (2) Characteristics Cases N= 26 Controls N= 81 P • Median length of stay 28 (12-94) 11 (8-18) <0.01 • Ward at hospital discharge 0,05 • Intensive care unit 0 0 • Surgical ward 9 (35) 27 (33) • Medical ward 14 (54) 53 (65) • Rehabilitation 3 (12) 1 (1) • Destination at discharge • Home 23 (88) 68 (84) 0.57 • Transfer 3 (12) 13 (16) • Health insurance beneficiaries 18 (69) 67 (83) 0.32 • Mean cost of hospitalisation, € (sd) 15,830 (4,320) 8,919 (2,447) <0.01

  12. G. Birgand ResultsMultivariate analysis • Final multivariate mixed models of ANOVA: Excess of length of stay = 22 days (12 - 34) Extra cost = 6,981€ (3,377 – 10,585) ECCMID Berlin 2013

  13. G. Birgand Discussion - Conclusion • The impact of stringent measures to control HDRB on hospital stays characteristics was estimated to: • 22 days (12-34) of mean excess LOS per Pt • 6,981€ (3,377 – 10,585) of mean extra costs per Pt • Strengths of this study: • Matching on patients comorbidity and DRG  Most costs are attributable to GRE or CPE • Limits of this study: • Single center study • Costs based on DRG and not individual data. • Perspectives: • Evaluation on a larger population at a multicenter level

  14. Thank you for your attention

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