ArticleBMJ open2017
Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Health Economic Evaluations in Intensive Care: An Updated Systematic Review.Critical care explorations · 2025Pooled it
- The neglected model validation of antimicrobial resistance transmission models - a systematic review.Antimicrobial resistance and infection control · 2025Pooled it
- Is systematic fecal carriage screening of extended-spectrum beta-lactamase-producing Enterobacteriaceae still useful in intensive care unit: a systematic review.Critical care (London, England) · 2019Pooled it
- Genetic characteristics and risk factors of extended-spectrum β-lactamase-producingMicrobiology spectrum · 2025Observational
- Electronic monitoring versus manual paper-based monitoring for hand hygiene compliance: a comprehensive health economic assessment analysis.BMC health services research · 2024Article
- Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study.Antimicrobial resistance and infection control · 2022Article
- Article
- Extended-spectrum beta-lactamases and plasmid diversity in urinary isolates of Escherichia coli in Croatia: a nation-wide, multicentric, retrospective study.Folia microbiologica · 2020Article
- Barrier Precautions in the Era of Multidrug Pathogens.Current treatment options in infectious diseases · 2020Review
- Modelling microbial infection to address global health challenges.Nature microbiology · 2019Review
- Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk.ClinicoEconomics and outcomes research : CEOR · 2018Article
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveSeveral control strategies have been used to limit the transmission of multidrug-resistant organisms in hospitals. However, their implementation is expensive and effectiveness of interventions for the control of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) spread is controversial. Here, we aim to assess the cost-effectiveness of hospital-based strategies to prevent ESBL-PE transmission and infections.
designCost-effectiveness analysis based on dynamic, stochastic transmission model over a 1-year time horizon. PATIENTS AND
settingPatients hospitalised in a hypothetical 10-bed intensive care unit (ICU
interventionsBase case scenario compared with (1) universal strategies (eg, improvement of hand hygiene (HH) among healthcare workers, antibiotic stewardship), (2) targeted strategies (eg, screening of patient for ESBL-PE at ICU admission and contact precautions or cohorting of carriers) and (3) mixed strategies (eg, targeted approaches combined with antibiotic stewardship). MAIN OUTCOMES AND MEASURES: Cases of ESBL-PE transmission, infections, cost of intervention, cost of infections, incremental cost per infection avoided.
resultsIn the base case scenario, 15 transmissions and five infections due to ESBL-PE occurred per 100 ICU admissions, representing a mean cost of €94 792. All control strategies improved health outcomes and reduced costs associated with ESBL-PE infections. The overall costs (cost of intervention and infections) were the lowest for HH compliance improvement from 55%/60% before/after contact with a patient to 80%/80%.
conclusionsImproved compliance with HH was the most cost-saving strategy to prevent the transmission of ESBL-PE. Antibiotic stewardship was not cost-effective. However, adding antibiotic restriction strategy to HH or screening and cohorting strategies slightly improved their effectiveness and may be worthy of consideration by decision-makers.
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