A cost analysis of active surveillance culture in a neonatal intensive care unit

Active surveillance culture (ASC) in neonatal intensive care units (NICUs) has been implemented to monitor horizontal transmission and choose appropriate antimicrobials when neonates experience late-onset infections (LOIs). To perform a cost analysis of ASC in the NICU, we evaluated data from a NICU ward in a Japanese community hospital. This was a retrospective study of neonates admitted to the NICU of Nara Prefecture General Medical Center, Nara City, Japan, from April 2012 to May 2017. We implemented biweekly ASC (nasal, stool and umbilical cultures) during this period. We assessed the detection rate for methicillin-sensitive and -resistant S. aureus (MSSA and MRSA) in each culture and reviewed the cases of LOI. Among the 785 cases, MSSA and MRSA were detected in 158 and 75 cases, respectively. Nasal culture was the most sensitive method for detecting MSSA and MRSA. Three cases benefitted from changing the empiric treatment based on previous ASC results, with an annual cost of ¥808,331 (£5773.80 or $7282.30) for ASC. The total cost per one benefited case during the study period was calculated as ¥1,392,126 (£9943.80 or $12,541.70). The total cost per benefited case in risk factor targeted ASC, nasal culture targeted ASC and MRSA-targeted ASC was ¥1,332,264 (£9516.20 or $12,002.30), ¥692,222 (£4944.40 or $6236.20) and ¥858,547 (£6132.50 or $7734.70), respectively. Considering the frequency of S. aureus detection and the cost of each culture, our ASC was modified to use only nasal cultures. This study suggests that the cost performance of ASC should be evaluated with consideration of the characteristics of each NICU.

Impact of a Methicillin-Resistant Staphylococcus Aureus Active Surveillance Culture Protocol on Mupirocin Prescribing

Background To identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), an active surveillance culture (ASC) protocol has been in place since March 2007. Decolonization with mupirocin ointment is not recommended but may be attempted after a positive MRSA screen. Objective Assess the impact of an inpatient ASC protocol on prescribing of mupirocin nasal ointment for decolonization before and after protocol implementation. Methods A retrospective review of mupirocin inpatient prescribing and outpatient clinic requests from March 2006 through February 2007 (1 year before ASC implementation) and from March 2007 through February 2008 (1 year after ASC implementation) was conducted. Cultures for MRSA after decolonization were evaluated. Results During the 24 months reviewed, 38 inpatients received mupirocin (18 before and 20 after ASC). Only 14 patients (37%) had a follow-up nasal swab (5 before and 9 after ASC). Of these patients, 5 (36%) had a positive nasal swab after the initial decolonization attempt. Ten patients (26%) had at least 1 clinical culture positive for MRSA after the initial decolonization (7 before and 3 after ASC). Outpatient requests for mupirocin increased 2.5-fold after ASC implementation. Sixty percent of the requests were not appropriate. Conclusion After implementation of the ASC protocol, there was no change in mupirocin prescribing for decolonization in the inpatient setting. However, outpatient requests—most of which were not indicated—increased. Success of decolonization cannot be assessed because follow-up nasal screening was not universally performed.