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Long-term clinical and economic benefits associated with the management of a nosocomial outbreak resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae

Piednoir, Emmanuel MD, PharmD, MSc; Thibon, Pascal MD, MSc; Borderan, Guy-Claude PharmD; Godde, Frédéric MD; Borgey, France MD, MSc; Le Coutour, Xavier MD; Parienti, Jean-Jacques MD, DTM&H, PhD

doi: 10.1097/CCM.0b013e31822827e0
Clinical Investigations

Objective: In 2005, there was an epidemic of infections resulting from extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the intensive care department. The aim of this study was to evaluate the potential long-term clinical and economic benefits resulting from the management of this epidemic and the resulting changes in practices.

Design: Two periods were defined: the period leading up to and including the epidemic (2003–2005; period I) and the postepidemic period (2006–2008; period II). We estimated the number of nosocomial infections prevented between these two periods in three ways: comparison of attack rates, incidence rates, and calculation of standardized infection ratios. A cost-benefit analysis was then carried out by multiplying the number of nosocomial infections prevented by their cost as estimated from a literature review.

Measurements and Main Results: The characteristics of the populations hospitalized during these two periods were comparable in terms of age, sex, Simplified Acute Physiologic Scale II score, origin, and type of diagnosis. The death rate was similar in the two periods (21.8% vs. 23.3%; p = .63). The number of nosocomial infections prevented was 54.1 (95% confidence interval 25.8–83.1; 30.4, 95% confidence interval 5.3–54.9; 32.8, 95% confidence interval 6.0–63.7; and 30.1, 95% confidence interval 17.7–42.5) according to the methodology. The savings cost potentially associated with the infection control intervention ranged from €149,928 (USD $183,781) to €269,472 (USD $330,318).

Conclusion: The management of this epidemic and the change in medical practices that it triggered were associated with a significant decrease in the number of infections acquired in the intensive care unit. There were substantial cost savings, highlighting the value of investment in the prevention of nosocomial infections.

From the Réseau Régional d'Hygiène (EP, PT, FB, XLC) and Département de Biostatistique et Recherche Clinique (J-JP), CHU Caen, France; Service de prévention du risque infectieux (EP, G-CB) and Département de réanimation polyvalente (FG), CH Avranches-Granville, France; Université de Caen Basse-Normandie (XLC, J-JP), Caen, France; INSERM UMR S707 (J-JP), Paris, France; and Université Pierre et Marie Curie-Paris 6 (J-JP), Paris, France.

The authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins