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

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dc.contributor.advisorPereira, Carlos Alberto Pires [UNIFESP]
dc.contributor.authorMarra, Alexandre Rodrigues
dc.contributor.authorCastelo Filho, Adauto [UNIFESP]
dc.contributor.authorCarmo Filho, José Rodrigues do
dc.contributor.authorCal, Ruy Guilherme Rodrigues [UNIFESP]
dc.contributor.authorSader, Helio Silva [UNIFESP]
dc.contributor.authorWey, Sergio Barsanti [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T12:38:13Z
dc.date.available2016-01-24T12:38:13Z
dc.date.issued2006-01-01
dc.description.abstractIntroduction: 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.en
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, Disciplina Doencas Infecc & Parasitarias, BR-04023062 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, Disciplina Doencas Infecc & Parasitarias, BR-04023062 São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent56-60
dc.identifierhttp://dx.doi.org/10.1016/j.ijid.2005.04.002
dc.identifier.citationInternational Journal of Infectious Diseases. Oxford: Elsevier B.V., v. 10, n. 1, p. 56-60, 2006.
dc.identifier.doi10.1016/j.ijid.2005.04.002
dc.identifier.fileWOS000235007200011.pdf
dc.identifier.issn1201-9712
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/28599
dc.identifier.wosWOS:000235007200011
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofInternational Journal of Infectious Diseases
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.subjectKlebsiella pneumoniaeen
dc.subjectESBLen
dc.subjectbloodstreamen
dc.subjectinfectionen
dc.subjecthospitalen
dc.subjectdetectionen
dc.titleHealth and economic outcomes of the detection of Klebsiella pneumoniae-produced extended-spectrum beta-lactamase (ESBL) in a hospital with high prevalence of this infectionen
dc.typeinfo:eu-repo/semantics/article
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