Active Surveillance for Carbapenemase-Producing, Carbepenem-Resistant Enterobacteriacaea (CP-CRE): Is the Current CP-CRE Screening Regimen In Our Hospital Effective and Cost Efficient?

Abstract

AIM: To evaluate the effectiveness and cost-efficiency of the CP-CRE screening regimen at our institution and explore modifications to optimise the process. BACKGROUND: CP-CRE poses a significant threat to healthcare institutions due to its resistance to antibiotics and association with increased mortality. Effective screening regimens are crucial for early detection and prevention of transmission. We studied the current screening practices to balance infection control with operational and financial sustainability. METHODS: A retrospective cohort study was conducted using CP-CRE screening data from September 2022 to August 2023. The dataset included 13,301 unique patient visits and 25,311 screening swabs. Routine surveillance was performed every seventh day of hospitalization. Positivity rates and cost implications were analysed, and a Generalized Additive Model (GAM) was used to assess the trend in positivity rates over the days of admission. Cost analysis involved calculating expenses and savings by modifying the screening regimen. RESULTS: The highest positivity rate (2.12%) was observed on day 10 of admission, an overall low positivity rate indicating effective infection control. Ceasing routine surveillance after day 21 could yield savings (SGD 672,900) but risks missing 6.4% of cases. The GAM analysis indicated a decline in positivity rates over time. CONCLUSIONS: The current CP-CRE screening regimen is effective but can be optimized for cost and operational efficiency. Focusing on high-risk periods and considering adjustments to the screening interval could enhance detection while reducing costs. Further studies are essential to refine these strategies, ensuring robust infection control without compromising financial sustainability.

Keywords

• CP-CRE
• Surveillance
• Colonisation