Costs Of Different Strategies Research Articles

Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report

BackgroundFor patients with heart failure combined with complete left bundle branch block, cardiac resynchronization therapy is an important therapeutic method. If these patients also have atrial tachycardia, how to choose a treatment strategy deserves discussion.Case presentationA Chinese woman in her early 70s was admitted due to recurrent episodes of chest distress and asthma for 1 year. Physical and laboratory examinations showed filling of the jugular vein, lung rales, left enlargement of the heart boundary, edema of the lower limbs and elevation of N-terminal pro b-type natriuretic peptide. An electrocardiogram showed atrial tachycardia and a left bundle branch block. An echocardiography revealed enlargement of the left ventricle and left ventricular systolic dysfunction. After obtaining informed consent, the treatment strategy decided upon by the team was to use biventricular cardiac resynchronization therapy treatment and to not intervene for the atrial tachycardia, with left bundle branch area pacing as a backup. Due to twisted and narrow coronary vein branches, traditional biventricular pacing failed, and then, left bundle branch area pacing was attempted successfully. A follow-up echocardiography at 1 year showed improved systolic function. The outcomes for this patient are favorable, but the choice of interventional strategy is worthy of discussion in this case.ConclusionFor patients with heart failure combined with left bundle branch block and atrial tachycardia, left bundle branch area pacing can replace traditional biventricular pacing for cardiac resynchronization therapy treatment, and the therapeutic effect is significant. However, multiple factors need to be considered when formulating strategies, including whether there is bundle branch block under sinus rhythm, the success and recurrence rate of atrial tachycardia ablation, the response of cardiac resynchronization therapy, the costs of different strategies, and instrument implantation issues.

Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in Medicare beneficiaries

Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking. To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis. Using the full sample (100%) of Medicare claims data, we performed a retrospective cohort study of diagnostic-naïve patients who received first-time ACM in 2017 to 2018 and evaluated arrhythmia encounter diagnosis at 3-months, repeat ACM testing at 6 months, all-cause 90-day emergency department (ED) and inpatient utilization, and cost of different strategies: Holter; long-term continuous monitor (LTCM); non-continuous, event-based external ambulatory event monitor (AEM); and mobile cardiac telemetry (MCT). We secondarily performed a device-specific analysis by manufacturer, identified from unique claim modifier codes. ACMs were used in 287,789 patients (AEM=10.3%; Holter=53.8%; LTCM=13.3%; MCT=22.5%). Device-specific analysis showed that compared to Holter, AEM, MCT, or other LTCM manufacturers, a specific LTCM (ZioⓇ XT 14-day patch, iRhythm Technologies, San Francisco, CA) had the highest adjusted odds of diagnosis and lowest adjusted odds of ACM retesting. Findings were consistent for specific arrhythmia diagnoses of ventricular tachycardia, atrioventricular block, and paroxysmal atrial fibrillation. As a category, LTCM was associated with the lowest 1-year incremental health care expenditures (mean Δ$10,159), followed by Holter ($10,755), AEM ($11,462), and MCT ($12,532). There was large variation in diagnostic monitoring strategy. A specific LTCM was associated with the highest adjusted odds of a new arrhythmia diagnosis and lowest adjusted odds of repeat ACM testing. LTCM as a category had the lowest incremental acute care utilization. Different monitoring strategies may produce different results with respect to diagnosis and care.

SMSG: Profiling-Free Parallelism Modeling for Distributed Training of DNN

The increasing size of deep neural networks (DNNs) raises a high demand for distributed training. An expert could find good hybrid parallelism strategies, but designing suitable strategies is time and labor-consuming. Therefore, automating parallelism strategy generation is crucial and desirable for DNN designers. Some automatic searching approaches have recently been studied to free the experts from the heavy parallel strategy conception. However, these approaches all rely on a numerical cost model, which requires heavy profiling results that lack portability. These profiling-based approaches cannot lighten the strategy generation work due to the non-reusable profiling value. Our intuition is that there is no need to estimate the actual execution time of the distributed training but to compare the relative cost of different strategies. We propose SMSG (Symbolic Modeling for Strategy Generation), which analyses the cost based on the communication and computation semantics. With SMSG, the parallel cost analyses are decoupled from hardware characteristics. SMSG defines cost functions for each kind of operator to quantitatively evaluate the amount of data for computation and communication, which eliminates the heavy profiling tasks. Besides, SMSG introduces how to apply functional transformation by using the Third Homomorphism theorem to control the high searching complexity. Our experiments show that SMSG can find good hybrid parallelism strategies to generate an efficient training performance similar to the state of the art. Moreover, SMSG covers a wide variety of DNN models with good scalability. SMSG provides good portability when changing training configurations that a profiling-based approach cannot.

Presumptive treatment or serological screening for schistosomiasis in migrants from Sub-Saharan Africa could save both lives and money for the Italian National Health System: results of an economic evaluation.

Schistosomiasis can lead to severe irreversible complications and death if left untreated. Italian and European guidelines recommend serological screening for this infection in migrants from Sub-Saharan Africa (SSA). However, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. This study aims to compare benefits and costs of different strategies to manage schistosomiasis in migrants from SSA to Italy. A decision tree and a Markov model were developed to assess the health and economic impacts of three interventions: (i) passive diagnosis for symptomatic patients (current practice in Italy); (ii) serological screening of all migrants and treating those found positive and (iii) presumptive treatment for all migrants with praziquantel in a single dose. The time horizon of analysis was one year to determine the exact expenses, and 28years to consider possible sequelae, in the Italian health-care perspective. Data input was derived from available literature; costs were taken from the price list of Careggi University Hospital, Florence, and from National Hospitals Records. Assuming a population of 100 000 migrants with schistosomiasis prevalence of 21·2%, the presumptive treatment has a greater clinical impact with 86.3% of the affected being cured (75.2% in screening programme and 44.9% in a passive diagnosis strategy). In the first year, the presumptive treatment and the screening strategy compared with passive diagnosis prove cost-effective (299 and 595 cost/QALY, respectively). In the 28-year horizon, the two strategies (screening and presumptive treatment) compared with passive diagnosis become dominant (less expensive with more QALYs) and cost-saving. The results of the model suggest that presumptive treatment and screening strategies are more favourable than the current passive diagnosis in the public health management of schistosomiasis in SSA migrants, especially in a longer period analysis.

A Model of Optimal Interval for Anti-Mosquito Campaign Based on Stochastic Process

Mosquito control is very important, in particular, for tropical countries. The purpose of mosquito control is to decrease the number of mosquitos such that the mosquitos transmitted diseases can be reduced. However, mosquito control can be costly, thus there is a trade-off between the cost for mosquito control and the cost for mosquitos transmitted diseases. A model is proposed based on renewal theory in this paper to describe the process of mosquitos’ growth, with consideration of the mosquitos transmitted diseases growth process and the corresponding diseases treatment cost. Through this model, the total mosquitos control cost of different strategies can be estimated. The optimal mosquito control strategy that minimizes the expected total cost is studied. A numerical example and corresponding sensitivity analyses are proposed to illustrate the applications.

A fuzzy approach in the study of COVID-19 pandemic in Brazil

PurposeThe COVID-19 pandemic has spread widely through the world. Most countries impose severe intervention measures to contain the spread of the virus, and this worldwide scenario has motivated the development of researches in all areas of knowledge. In this context, this paper presents a study about how intervention measures such as lockdown, partial lockdown, and no-lockdown help to impede the extent of the severe outbreak of COVID-19.MethodsSince mathematical models are used to describe population dynamics and the behavior of epidemics, this paper presents a fuzzy approach to describe the behavior of new daily cases of COVID-19 in Brazil based on the p-fuzzy dynamic systems, considering as input variables, the infected population and the environment action. The evaluated output variable is the level of infestation.ResultsThe results of a fuzzy model showed that intervention measures play a crucial role in determining the success of COVID-19 eradication programs, while there is no vaccine available for all the population. The proposed fuzzy model was developed by posing intervention measures and the results showed that to consider partial-lockdown helped to slow down the transmission rates of COVID-19 in the population, however the total lockdown is more effective, while the vaccine is not available.ConclusionTherefore, mathematical models consist of an effective tool to investigate the situation with intervention strategies and estimate the potential benefits and costs of different strategies. The fuzzy model proposed assists government decision-making in order to minimize the economic impacts caused by the pandemic.

Improving reconstructive surgery design using Gaussian process surrogates to capture material behavior uncertainty

To produce functional, aesthetically natural results, reconstructive surgeries must be planned to minimize stress as excessive loads near wounds have been shown to produce pathological scarring and other complications (Gurtner et al., 2011). Presently, stress cannot easily be measured in the operating room. Consequently, surgeons rely on intuition and experience (Paul et al., 2016; Buchanan et al., 2016). Predictive computational tools are ideal candidates for surgery planning. Finite element (FE) simulations have shown promise in predicting stress fields on large skin patches and in complex cases, helping to identify potential regions of complication. Unfortunately, these simulations are computationally expensive and deterministic (Lee et al., 2018a). However, running a few, well selected FE simulations allows us to create Gaussian process (GP) surrogate models of local cutaneous flaps that are computationally efficient and able to predict stress and strain for arbitrary material parameters. Here, we create GP surrogates for the advancement, rotation, and transposition flaps. We then use the predictive capability of these surrogates to perform a global sensitivity analysis, ultimately showing that fiber direction has the most significant impact on strain field variations. We then perform an optimization to determine the optimal fiber direction for each flap for three different objectives driven by clinical guidelines (Leedy et al., 2005; Rohrer and Bhatia, 2005). While material properties are not controlled by the surgeon and are actually a source of uncertainty, the surgeon can in fact control the orientation of the flap with respect to the skin's relaxed tension lines, which are associated with the underlying fiber orientation (Borges, 1984). Therefore, fiber direction is the only material parameter that can be optimized clinically. The optimization task relies on the efficiency of the GP surrogates to calculate the expected cost of different strategies when the uncertainty of other material parameters is included. We propose optimal flap orientations for the three cost functions and that can help in reducing stress resulting from the surgery and ultimately reduce complications associated with excessive mechanical loading near wounds.

Economic Evaluation in Opioid Modeling: Systematic Review

ObjectivesThe rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. MethodsA systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. ResultsThe screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies’ accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. ConclusionThe review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.

Economic Evaluation in Opioid Modeling: Systematic Review

Background: The opioid crisis is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to understand its complexity and to evaluate the potential costs of different strategies to address this problem. Methods: A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a pre-defined set of items and a quality assessment were performed for each study. Results: The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Most analyses (78%) assessed the cost-utility or cost-effectiveness of two or more interventions. Less than half (39%) adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Consideration of patient and physician preference, changing costs, result stratification, or prevention was infrequent. High heterogeneity in study designs and outcomes precluded a meta-analysis. Conclusions: The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid antagonist treatments (methadone or buprenorphine maintenance treatments against no naloxone distribution and no treatment, respectively). The review observes gaps in accounting for patient and physician preferences or major changes in medication prices.

Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: a modelling analysis

The WHO elimination strategy for hepatitis C virus advocates scaling up screening and treatment to reduce global hepatitis C incidence by 80% by 2030, but little is known about how this reduction could be achieved and the costs of doing so. We aimed to evaluate the effects and cost of different strategies to scale up screening and treatment of hepatitis C in Pakistan and determine what is required to meet WHO elimination targets for incidence. We adapted a previous model of hepatitis C virus transmission, treatment, and disease progression for Pakistan, calibrating using available data to incorporate a detailed cascade of care for hepatitis C with cost data on diagnostics and hepatitis C treatment. We modelled the effect on various outcomes and costs of alternative scenarios for scaling up screening and hepatitis C treatment in 2018-30. We calibrated the model to country-level demographic data for 1960-2015 (including population growth) and to hepatitis C seroprevalence data from a national survey in 2007-08, surveys among people who inject drugs (PWID), and hepatitis C seroprevalence trends among blood donors. The cascade of care in our model begins with diagnosis of hepatitis C infection through antibody screening and RNA confirmation. Diagnosed individuals are then referred to care and started on treatment, which can result in a sustained virological response (effective cure). We report the median and 95% uncertainty interval (UI) from 1151 modelled runs. One-time screening of 90% of the 2018 population by 2030, with 80% referral to treatment, was projected to lead to 13·8 million (95% UI 13·4-14·1) individuals being screened and 350 000 (315 000-385 000) treatments started annually, decreasing hepatitis C incidence by 26·5% (22·5-30·7) over 2018-30. Prioritised screening of high prevalence groups (PWID and adults aged ≥30 years) and rescreening (annually for PWID, otherwise every 10 years) are likely to increase the number screened and treated by 46·8% and decrease incidence by 50·8% (95% UI 46·1-55·0). Decreasing hepatitis C incidence by 80% is estimated to require a doubling of the primary screening rate, increasing referral to 90%, rescreening the general population every 5 years, and re-engaging those lost to follow-up every 5 years. This approach could cost US$8·1 billion, reducing to $3·9 billion with lowest costs for diagnostic tests and drugs, including health-care savings, and implementing a simplified treatment algorithm. Pakistan will need to invest about 9·0% of its yearly health expenditure to enable sufficient scale up in screening and treatment to achieve the WHO hepatitis C elimination target of an 80% reduction in incidence by 2030. UNITAID.

The cost of eliminating hepatitis C in Pakistan

The cost of eliminating hepatitis C in Pakistan

Economic Evaluation of Strategies For Public Cervical Cancer Screening

The aim of this study was to evaluate the strategies for China public cervical cancer screening and make recommendations on selecting the optimal strategy by comparing the screening effectiveness and disease management costs of different strategies. A Markov cohort model was developed to simulate 2 cycles of cervical cancer screening in women aged from 30 to 65 in population of 1,000,000. The costs and effectiveness of different strategies were calculated from the perspective of China’s healthcare system. Five strategies were compared, including cytology only primary screening, cytology primary screening with reflex to CINtec PLUS, HPV primary screening with reflex to cytology, HPV 16/18 genotyping primary screening with reflex to cytology, and HPV 16/18 genotyping primary screening with reflex to CINtec PLUS. In the cytology primary screening strategy groups, more CIN2+ cases could be detected at less cost per case of CIN2+ detected when using CINtec PLUS as reflex, which will also decrease annual incidence and mortalities of cervical cancers. In the HPV primary screening strategy groups, introducing HPV 16/18 genotyping will help identify more CIN2+ cases at less cost per case of CIN2+ detected, and further reduce the annual incidence and mortalities of cervical cancers. And HPV 16/18 genotyping with reflex to CINtec PLUS screening strategy can find the most CIN2+ cases at the least cost per case of CIN2+ detected and deliver the least annual incidence and mortalities of cervical cancers. In general, compared with the cytology primary screening strategy, the HPV primary screening strategy can prolong screening interval, which will cause small decline of total annual cost and meanwhile substantially improve screening effectiveness. HPV 16/18 genotyping with reflex to CINtec PLUS screening strategy is the optimal strategy with the best screening effectiveness if the total budget is affordable.

Cost‐benefit analysis of shrimp farming's flood risk reduction strategies in Thailand

Chachoengsao province is a prime shrimp producing area for domestic consumption and exports. The province, however, is often threatened by floods. Improving the effectiveness of current flood damage protection is a major challenge. This research developed a flood risk map by combining the probability of flood events and a vulnerability map based on physical characteristics of the area and socio‐economic conditions of shrimp farmers (victims). Analysis of current risk reduction measures was performed by comparing the net benefits and costs of different strategies. Damage costs to shrimp farming from flooding were also estimated for the base case (a case with no change in actions). The flood risk map shows that two‐thirds of shrimp farms are highly vulnerable to flooding when a 10‐day accumulated rainfall is greater than 250 mm which is likely to occur every 2 years. Increasing dike heights could yield higher net benefits than other flood adaptation measures. Non‐structural flood controls such as early harvesting and shifting the crop calendar are alternative measures for shrimp farmers who lack financial supports. The results show that cost‐benefit analysis based on various scenarios can help in selecting an appropriate mitigation practice especially for shrimp farms located in a high risk area.

Achieving change in primary care—effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews

ObjectiveTo identify, summarise and synthesise available literature on the effectiveness of implementation strategies for optimising implementation of complex interventions in primary care.DesignSystematic review of reviews.Data sourcesMEDLINE, EMBASE, CINAHL, Cochrane Library...

Screening Performance and Costs of Different Strategies in Prenatal Screening for Trisomy 21

Objective: Cell-free fetal DNA (cffDNA) testing has opened new options in prenatal screening for trisomy 21. Due to the higher costs of cffDNA testing there is an ongoing debate on how to combine different screening strategies. Methods: For this study, a model-based approach was used to evaluate all births in Germany in 2012 together with the percentage of euploid and trisomic pregnancies. Detection rates (DR), false positive rates (FPR), the costs of different screening strategies for trisomy 21 and combinations of these strategies were compared. The number of fetuses with trisomy 21 at 12 + 0 weeks of gestation was estimated based on maternal age distribution. We examined the screening performance of a screening strategy based on maternal age, first trimester screening (FTS) and cffDNA testing as well as the combinations “maternal age and cffDNA” and “FTS and cffDNA”. Results: In 2012 673 544 children were born. Median maternal age at delivery was 30.2 years (25th–75th quartile: 27.0–34.0). Based on maternal age distribution the expected number of fetuses with trisomy 21 at 12 weeksʼ gestation was 1788. Our study population therefore consisted of 675 332 pregnancies. Screening based only on maternal age or FTS or cffDNA resulted in detection rates of 63.3 %, 92.2 % and 99.0 % and false positive rates of 21.8 %, 8.0 % and 0.1 %, respectively. When maternal age was combined with cffDNA, cffDNA testing was only offered to women over a certain age; if a cut-off of 30 years was used, this resulted in a DR of 85.2 % and a FPR of 1.7 %. If primary screening consisted of FTS with cffDNA testing only done when the risk was between 1 : 10 and 1 : 1000, the detection rate was 96.7 % and the false positive rate was 1.2 %. Conclusion: In this model-based study we showed that prenatal screening for trisomy 21 can be improved even more by combining FTS and cffDNA. Further studies are necessary to examine whether these results can be reproduced in reality.

Screening Performance and Costs of Different Strategies in Prenatal Screening for Trisomy 21.

Objective: Cell-free fetal DNA (cffDNA) testing has opened new options in prenatal screening for trisomy 21. Due to the higher costs of cffDNA testing there is an ongoing debate on how to combine different screening strategies. Methods: For this study, a model-based approach was used to evaluate all births in Germany in 2012 together with the percentage of euploid and trisomic pregnancies. Detection rates (DR), false positive rates (FPR), the costs of different screening strategies for trisomy 21 and combinations of these strategies were compared. The number of fetuses with trisomy 21 at 12 + 0 weeks of gestation was estimated based on maternal age distribution. We examined the screening performance of a screening strategy based on maternal age, first trimester screening (FTS) and cffDNA testing as well as the combinations "maternal age and cffDNA" and "FTS and cffDNA". Results: In 2012 673 544 children were born. Median maternal age at delivery was 30.2 years (25th-75th quartile: 27.0-34.0). Based on maternal age distribution the expected number of fetuses with trisomy 21 at 12 weeks' gestation was 1788. Our study population therefore consisted of 675 332 pregnancies. Screening based only on maternal age or FTS or cffDNA resulted in detection rates of 63.3 %, 92.2 % and 99.0 % and false positive rates of 21.8 %, 8.0 % and 0.1 %, respectively. When maternal age was combined with cffDNA, cffDNA testing was only offered to women over a certain age; if a cut-off of 30 years was used, this resulted in a DR of 85.2 % and a FPR of 1.7 %. If primary screening consisted of FTS with cffDNA testing only done when the risk was between 1 : 10 and 1 : 1000, the detection rate was 96.7 % and the false positive rate was 1.2 %. Conclusion: In this model-based study we showed that prenatal screening for trisomy 21 can be improved even more by combining FTS and cffDNA. Further studies are necessary to examine whether these results can be reproduced in reality.

Effectiveness And Costs Of Different Strategies For The Diagnosis Of Stable Coronary Artery Disease Results From The Evinci Study.

Effectiveness And Costs Of Different Strategies For The Diagnosis Of Stable Coronary Artery Disease Results From The Evinci Study.

Estimating the cost of different strategies for measuring farmland biodiversity: Evidence from a Europe-wide field evaluation

Forty percent of the EU land area is currently considered to be agriculturally managed (utilised agricultural area – UAA – Eurostat Agricultural Census 2010), and attention to the environmental performance of farming practices is growing. To determine the performance of agricultural practices, farm-scale monitoring programmes are required but their implementation is hampered by a number of difficulties such as the identification of broadly applicable indicators appropriate for different biogeographic locations, and the evaluation of the effectiveness and costs of different monitoring approaches. In this paper, we focus on the costs of farm-scale biodiversity monitoring, presenting results from a Europe-wide cost data collection in the EU FP7 BioBio Project. Firstly, we present an analytical assessment of resources consumed by the research units and a cost estimation for the measurement of six biodiversity-related parameters: farm habitats, vegetation, wild bees and bumblebees, spiders, earthworms and farm management. Thereafter, we estimate a standardised cost for an ordinary measurement of the six parameters at farm-scale. In doing so, we highlight the cost differences between three strategies involving different potential actors (professional agencies, farmers, volunteers). This analysis demonstrates that producing reliable data on monitoring costs requires a large sample pool of farms and farm types, as was the case in the BioBio project. The cost standardisation allowed us to estimate a cost for biodiversity monitoring ranging between €2700 and €8200 per farm, depending on the chosen strategy.

People consider reliability and cost when verifying their autobiographical memories

Because memories are not always accurate, people rely on a variety of strategies to verify whether the events that they remember really did occur. Several studies have examined which strategies people tend to use, but none to date has asked why people opt for certain strategies over others. Here we examined the extent to which people's beliefs about the reliability and the cost of different strategies would determine their strategy selection. Subjects described a childhood memory and then suggested strategies they might use to verify the accuracy of that memory. Next, they rated the reliability and cost of each strategy, and the likelihood that they might use it. Reliability and cost each predicted strategy selection, but a combination of the two ratings provided even greater predictive value. Cost was significantly more influential than reliability, which suggests that a tendency to seek and to value “cheap” information more than reliable information could underlie many real-world memory errors.

Utility of Surveillance Cultures for Antimicrobial Resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit

Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits and costs of different strategies have not been fully evaluated. We conducted a retrospective study in 2 level III NICUs from 2004 to 2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods. Risk factors, selected outcomes and laboratory costs associated with ARO colonization were assessed. Among 1751 infants studied, the rate of colonization for methicillin-resistant S. aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods was 3%, 1.7% and 1%, respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at ≥ 7 days of life had 5.8 increased odds of ARO colonization compared with infants <7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection and duration of hospitalization compared with those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425. The rate of colonization with AROs at transfer was low particularly in infants <7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants.