The Potential Economic Value of Multi-drug Resistant Acinetobacter baumannii Screening in the Intensive Care Unit (ICU)

Background: Acinetobacter baumannii is one of the most challenging gram-negative pathogens to control and treat in the intensive care unit (ICU), causing serious infections in critically ill patients and resulting in substantial morbidity and costs.  Although A.  baumannii is an increasingly common nosocomial pathogen, currently, most ICUs do not actively screen admissions.  

Objective: To determine the potential economic value to the hospital of implementing active multidrug resistant (MDR) A. baumannii screening of ICU admissions.

Methods: We developed an economic computer simulation model to determine the potential economic value of implementing routine MDR A. baumannii screening of ICU admissions and isolating those patients who tested positive.  We compared two screening methods, sponge and swab, to each other and no screening.  Sensitivity analysis varied MDR A. baumannii colonization prevalence, percentage of colonized individuals who had active infections, A. baumannii reproductive rate (R), and contact isolation efficacy.  

Results: Both screening methods were cost-saving for almost all scenarios tested.  Cost-savings ranged from -$1 to -$1,563, for either screening method compared to no screening.  Sponge screening was not cost-saving when colonization prevalence ≤1%, probability of infection ≤30%, R ≤0.25, and contact isolation efficacy ≤25%.  Swab screening was not cost-saving under these same conditions when the probability of infection was ≤40%.  Sponge screening tended to be more cost-saving than swab screening, with additional savings ranging from $1 to $421.   

Conclusions: Routinely screening ICU patients for MDR A. baumannii may provide economic value to hospitals.