Health and economic outcomes of the detection of Klebsiella pneumoniae-produced extended-spectrum beta-lactamase (ESBL) in a hospital with high prevalence of this infection

Health and economic outcomes of the detection of Klebsiella pneumoniae-produced extended-spectrum beta-lactamase (ESBL) in a hospital with high prevalence of this infection

Author Marra, Alexandre Rodrigues Google Scholar
Castelo Filho, Adauto Autor UNIFESP Google Scholar
Carmo Filho, José Rodrigues do Google Scholar
Cal, Ruy Guilherme Rodrigues Autor UNIFESP Google Scholar
Sader, Helio Silva Autor UNIFESP Google Scholar
Wey, Sergio Barsanti Autor UNIFESP Google Scholar
Advisor Pereira, Carlos Alberto Pires Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Introduction: Klebsiella pneumoniae is of high prevalence in hospital infections, mainly in bloodstream infections (BSI), and some produce extended-spectrum beta-lactamase (ESBL). for hospitals with a high prevalence of strains producing this enzyme, there is no reference material to show whether the use of the E-test method for their detection, which can be quite expensive, is actually required.Objective: To evaluate the cost-benefit of the disk diffusion and E-test methods for the detection of ESBL-producing K. pneumoniae strains in hospitals where a high prevalence of this resistance mechanism in BSI is found.Methods: One hundred and eight patients with K. pneumoniae BSI were evaluated retrospectively. ESBL-producing strains were identified by the disk diffusion method and by the E-test method. We estimated the costs of both diagnostic methods based on antimicrobial therapy adequacy.Results: Fifty-two percent of K. pneumoniae infections were due to ESBL-producing strains. the disk diffusion method yielded a positive predictive value (PPV) of 94.7% (95% Cl: 88.9-100%) and a negative predictive value (NPV) of 96.1% (CI 95%: 90.8-101.4%) in relation to the E-test. We evaluated cost-effectiveness, i.e., we analyzed the cost of both E-test and disk diffusion methods with carbapenem and cephalosporins, and found that the use of the disk diffusion method accounts for approximately US$3300.Conclusions: in hospitals with a high prevalence of ESBL-producing strains, the disk diffusion method can be used to detect ESBL-producing K. pneumoniae without compromising the clinical progression of patients with BSI. the E-test showed higher accuracy but this method was more expensive than the disk diffusion method. However, the use of the E-test method was demonstrated to be more cost-effective, as we evaluated cost based on antimicrobial therapy adequacy. (C) 2005 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.
Keywords Klebsiella pneumoniae
ESBL
bloodstream
infection
hospital
detection
Language English
Date 2006-01-01
Published in International Journal of Infectious Diseases. Oxford: Elsevier B.V., v. 10, n. 1, p. 56-60, 2006.
ISSN 1201-9712 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 56-60
Origin http://dx.doi.org/10.1016/j.ijid.2005.04.002
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000235007200011
URI http://repositorio.unifesp.br/handle/11600/28599

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