Abstract:
OBJECTIVE To evaluate the effectiveness and health economic benefits of implementing a single-screening strategy upon admission for carbapenem-resistant Enterobacteriaceae （CRE） in high-prevalence areas.
METHODS Microsimulation modeling was adopted to analyze the impact of a single-screening strategy upon admission on 1 000 patients admitted to the ICU of four three-A hospitals in Shanghai from 2010 to 2020. The primary outcomes included CRE-related infection rates, bacteremia, pulmonary infections, urinary tract infections, mortality rates, length of hospital stay and medical costs. It was assumed that screening results were reported within 24 hours, and isolation measures were implemented for all patients who tested positive. The study data were derived from retrospective analyses of multiple general hospitals in China and validated with relevant domestic and international literature.
RESULTS Implementing a single-screening strategy upon admission reduced the CRE-related infection rate by 22‰ （declining from 35‰ to 13‰）, the incidence of bacteremia by 8‰ （from 15‰ to 7‰）, the incidence of pulmonary infections by 6‰ （from 12‰ to 6‰） and the incidence of urinary tract infections by 5‰ （from 8‰ to 3‰）. The incremental cost-effectiveness ratio （ICER） of screening was -1 544.45 yuan per quality-adjusted life year （QALY）, and the strategy was cost-effective in most scenarios in environments with a prevalence rate ≥5%.
CONCLUSIONS A single-screening strategy for CRE upon admission in ICUs in high-prevalence areas can reduce infection rates, decrease cross-transmission, and improve prognosis. Although influenced by factors such as screening methods, isolation compliance and detection delays, this strategy holds value in environments with a high prevalence of CRE.
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